Very early versus early endoscopy in acute non-variceal upper gastrointestinal bleeding: A prospective cohort study...

To evaluate whether endoscopy within 12h improves clinical outcomes compared with endoscopy performed between 12 and 24h in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB).

This prospective cohort study included adults with acute NVUGIB who underwent upper GI endoscopy within 24h of emergency department presentation. Patients were grouped according to endoscopy timing: within 12h and between 12 and 24h. Clinical outcomes were compared before and after propensity score matching. The primary outcome was a 30-day composite adverse outcome, defined as death or rebleeding.

A total of 285 patients were included, of whom 108 underwent endoscopy within 12h and 177 between 12 and 24h. After PSM, 103 patients remained in each group. The 30-day composite adverse outcome was similar between the within-12-h and 12-24-h groups (6.8% vs. 7.8%, p=1.000). No significant differences were observed in 30-day mortality (4.9% vs. 2.9%, p=0.727), rebleeding (1.9% vs. 5.8%, p=0.289), ICU admission (29.1% vs. 35.9%, p=0.371), inotropic support (3.9% vs. 6.8%, p=0.549), or prolonged hospitalization (24.3% vs. 31.1%, p=0.324). In multivariable logistic regression, endoscopy within 12h was not independently associated with the 30-day composite adverse outcome (adjusted OR 0.768, 95% CI 0.313-1.881; p=0.564).

In acute NVUGIB managed within the 24-h window, routine endoscopy within 12h was not associated with a statistically significant improvement in clinical outcomes compared with endoscopy performed between 12 and 24h, supporting risk-adapted timing after stabilization.