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Identifying Low-Risk Patients with Cirrhosis and Acute Gastrointestinal Bleeding That May Not Require Urgent
Sijia Zhang1, Mingyu Sun2, Shanshan Yuan3
1Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Teaching Hospital of China Medical University), No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China.
Insights
Urgent endoscopy may not be necessary for low-risk cirrhosis patients with acute gastrointestinal bleeding presenting with melena alone. These patients, with Child-Pugh score ≤7 and no hepatocellular carcinoma, had similar outcomes whether they underwent endoscopy or not.
Area of Science:
- Gastroenterology
- Hepatology
- Internal Medicine
Background:
- Urgent endoscopy for cirrhosis patients with acute gastrointestinal bleeding (AGIB) is resource-intensive and carries risks.
- Identifying low-risk patients who may not require this invasive procedure is crucial.
Purpose of the Study:
- To identify patients with cirrhosis and AGIB who can safely forgo hospitalization endoscopy.
- To evaluate the necessity of endoscopy in low-risk cirrhotic patients with melena.
Main Methods:
- Retrospective analysis of 673 patients with cirrhosis and AGIB presenting with melena alone.
- Classification based on endoscopy use and assessment of Child-Pugh score and hepatocellular carcinoma (HCC) association with in-hospital death.
Main Results:
- 30.0% of patients (202/673) did not undergo endoscopy.
- Among 304 low-risk patients (Child-Pugh score ≤7, no HCC), in-hospital mortality was 0.0% regardless of endoscopy.
- No significant difference in 5-day bleeding control failure rates between endoscopic and non-endoscopic groups in this low-risk population.
Conclusions:
- Low-risk patients with cirrhosis, AGIB, melena, Child-Pugh score ≤7, and no HCC may not require urgent endoscopy.
- This finding could help optimize resource allocation and reduce procedural risks in managing these patients.
Introduction:
Urgent endoscopy should be performed in patients with cirrhosis and acute gastrointestinal bleeding (AGIB), but this approach is resource-intensive and associated with procedural risks. Therefore, its necessity has been questioned in low-risk patients. This study aims to identify low-risk patients with cirrhosis and AGIB for whom endoscopy may be unnecessary during hospitalization.
Methods:
Patients with cirrhosis and AGIB who presented with melena alone were retrospectively screened from an international multicenter cohort. They were further classified according to the use of endoscopy. Logistic regression analyses were performed to explore the relationship of Child-Pugh score and hepatocellular carcinoma (HCC) with in-hospital death.
Results:
Overall, 673 patients were included, of whom 202 (30.0%) did not undergo endoscopy. Child-Pugh score and HCC were significantly associated with in-hospital mortality. There was no death during hospitalization among the 304 patients with Child-Pugh score ≤ 7 and without HCC, who were stratified as a low-risk population. Among them, neither in-hospital mortality (0.0% vs. 0.0%) nor rate of 5-day failure to control bleeding (1.3% vs. 4.7%, P = 0.110) was significantly different between patients who underwent endoscopy and those who did not.
Conclusions:
Patients with cirrhosis and AGIB, who present with melena alone, and have Child-Pugh score ≤ 7, but without HCC, may not require urgent endoscopy.
Trial Registration:
This study is a secondary analysis based on the data from our previously registered study (ClinicalTrials.gov identifier NCT04662918).
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