Timing of endoscopy in cirrhotic patients with acute variceal bleeding: a multicenter cohort study

The optimal timing of endoscopy in cirrhotic patients with acute variceal bleeding (AVB) remains uncertain. The study aimed to determine whether the timing of endoscopy affects short-term outcomes in patients with AVB.

Cirrhotic patients with AVB who underwent endoscopy within 24 hours of admission between 2016-2022 were evaluated. Patients were categorized into two group: the urgent endoscopy group (<12 hours) and the early endoscopy group (12-24 hours). The primary outcome was 30-day mortality. Secondary outcomes included the incidence of treatment failure, the need for intensive care unit (ICU) and the length of hospital stay (LOS). A multivariate analysis was performed to identify risk factors for 30-day mortality.

A total of 183 patients were enrolled. Of them, 89 patients (48.6%) underwent urgent endoscopy, while 94 patients (51.4%) underwent early endoscopy. There were no significant differences between the urgent and early endoscopy groups, in terms of short-term mortality (6.7% vs. 7.4%, P=0.541), treatment failure (12.4% vs. 10.6%, P=0.445) or the incidence of ICU admission (3.4% vs. 6.4%, P=0.075). However, the LOS was longer in patients in the urgent endoscopy group compared to the early endoscopy group (14.1 vs. 11.9, P=0.001). In the multivariate analysis, MELD-Na score (aHR 1.21, 95% CI 1.12-1.48) and Glasgow-Blatchford score (aHR 2.71, 95% CI 1.45-5.08) were identified as independent risk factors for 30-day mortality.

Performing urgent endoscopy within 12 hours of admission in patients with cirrhosis and AVB, rather than within 12 to 24 hours, did not improve short-term outcomes.