Timing of endoscopy and short-term outcomes in cirrhotic patients with acute variceal bleeding: a single-center retrospective study

The optimal timing of endoscopy for acute variceal bleeding (AVB) remains uncertain in real-world clinical practice. This study aimed to evaluate the association between endoscopy timing and short-term outcomes in patients with AVB.

We retrospectively included cirrhotic patients with endoscopically confirmed AVB admitted between January 2020 and April 2025 who underwent endoscopic therapy during hospitalization. Patients were categorized according to time from admission to endoscopy: <24 h, 24-72 h, and ≥ 72 h. The primary outcomes were 6-week mortality and rebleeding. Secondary outcomes included length of hospital stay, hospitalization cost, and transfusion requirements. Multivariable logistic regression, Firth penalized logistic regression, subgroup analyses, and sensitivity analyses were performed.

A total of 213 patients were included. Compared with endoscopy within 24 h, endoscopy at 24-72 h was associated with higher odds of 6-week mortality (aOR 21.7, 95% CI 2.50-390, p = 0.003) and rebleeding (aOR 3.35, 95% CI 1.12-11.0, p = 0.036). Endoscopy at ≥ 72 h was associated with higher odds of 6-week mortality in the main model (aOR 9.77, 95% CI 1.12-172, p = 0.038), but this association was less consistent across sensitivity analyses. Sensitivity analyses generally supported the association observed for the 24-72 h group. For secondary outcomes, delayed endoscopy was associated with longer hospital stay, whereas endoscopy at 24-72 h was associated with lower transfusion requirements.

Endoscopy timing was associated with short-term outcomes in patients with AVB. Endoscopy at 24-72 h was associated with higher odds of 6-week mortality and rebleeding compared with endoscopy within 24 h, whereas findings for endoscopy beyond 72 h were less consistent across sensitivity analyses. These findings support individualized endoscopy timing after adequate resuscitation and stabilization.