Coffee ground emesis and early endoscopy: Is timing actually relevant?

Area of Science:

• Gastroenterology
• Clinical Medicine
• Medical Diagnostics

Background:

• Coffee ground vomiting is a recognized symptom of upper gastrointestinal bleeding.
• Its clinical utility is limited by a low positive predictive value.
• The impact of urgent endoscopy on patient outcomes requires further investigation.

Purpose of the Study:

• To evaluate if urgent endoscopy modifies therapeutic management and impacts survival in patients with coffee ground vomiting.
• To assess the clinical usefulness of coffee ground vomiting as an indicator for upper gastrointestinal bleeding.

Main Methods:

• Retrospective, observational, and descriptive study of patients undergoing gastroscopy for coffee ground vomiting (2017-2021).
• Comparison of outcomes between urgent (within 24h) and scheduled (after 24h) endoscopy groups.
• Analysis included survival, ICU admission, hospitalization duration, and rebleeding rates.

Main Results:

• No significant differences were observed in ICU admission, hospitalization days, survival, or 30-day rebleeding between urgent and scheduled endoscopy groups.
• The number of identified bleeding lesions and the need for therapeutic endoscopy were similar across both groups.
• 276 patients were included (176 urgent, 109 scheduled).

Conclusions:

• Coffee ground vomiting, in isolation, is an unreliable indicator of upper gastrointestinal bleeding.
• Urgent endoscopy does not improve morbimortality outcomes for patients presenting with this symptom.
• A conservative endoscopic strategy may reduce risks and costs without compromising patient prognosis.