Impact of Urgent Versus Early Endoscopy on Outcomes in Acute Upper Gastrointestinal Bleeding: A Retrospective Study

Acute upper gastrointestinal (UGI) bleeding from variceal and nonvariceal sources is a leading cause of morbidity and mortality. Although current international guidelines recommend performing endoscopy within 24 h of presentation, the added value of very early ("urgent," < 6 h) versus "early" (6-24 h) endoscopy remains unclear. Therefore, this study aimed to analyze the impact of urgent versus early endoscopy on clinical outcomes.

In this retrospective cohort study, we reviewed the medical records of 599 patients admitted to the emergency or gastroenterology department who underwent UGI endoscopy. Patients were stratified by timing, urgent endoscopy within 6 h of specialist consultation and early endoscopy between 6-24 h postconsultation. The protocol was approved by the University of Rzeszów Ethics Committee and conducted in accordance with the Declaration of Helsinki.

Compared to the early group, patients undergoing urgent endoscopy were younger (p = 0.013), predominantly male, and had higher baseline heart rates (p = 0.0371). Apart from more frequent hypertension in the early group (p = 0.0007), comorbiditiy profiles were otherwise similar. The urgent endoscopy group had longer hospital stays (6.88 vs. 5.95, p = 0.774), more frequent rebleeding within 7 days (p = 0.0213), and slightly higher 30-day all-cause mortality rates. Factors associated with poor prognosis included increases in Rockall's and GB's scores (42% and 19% higher risk per point, respectively) and the presence of active bleeding (105% higher odds).

In unadjusted analyses, urgent endoscopy (< 6 h) was associated with worse outcomes, likely reflecting the selection of more severely ill patients. After propensity-score matching for baseline risk factors, however, the timing of endoscopy (< 6 h vs. 6-24 h) was no longer an independent predictor of outcomes. These findings suggest that clinicians' decisions and outcome differences are driven by overall severity of presentation and comorbid burden, rather than the effect of ultra-early endoscopy itself.