Endoscopy timing in managing acute esophagogastric variceal bleeding: a multicenter retrospective study

Patients suffering from acute esophagogastric variceal bleeding (AEGVB) frequently face unfavorable prognoses. Although endoscopy is the preferred intervention for AEGVB, the optimal timing for its administration to enhance patient outcomes remains a subject of ongoing debate.

This study encompassed patients with cirrhosis who presented with AEGVB and received endoscopic treatment at three major tertiary hospitals in Shandong Province, China, from January 2017 to July 2024. Participants were stratified based on the time interval from hospital admission to endoscopic intervention (<12 hours vs. ≥12 hours; <24 hours vs. ≥24 hours; <48 hours vs. ≥48 hours; <72 hours vs. ≥72 hours). Propensity score matching (PSM) was utilized in a 1:1 ratio for each group. Subgroup analyses were performed based on patients' hematemesis status, Child-Pugh classification, and Model for End-Stage Liver Disease (MELD) score. The primary outcomes assessed included overall post-endoscopic rebleeding, 5-day rebleeding, 6-week rebleeding, rebleeding beyond 180 days, in-hospital mortality, and 6-week mortality. Furthermore, a multivariable Cox proportional hazards regression model was employed to identify risk factors for rebleeding.

Overall, 1,125 patients who underwent endoscopic intervention for AEGVB were included. Prior to PSM, the group undergoing endoscopy within 12 hours exhibited a significantly higher in-hospital mortality rate compared to the group undergoing endoscopy after 12 hours (3.3% vs. 0.5%, P=0.010). Post-PSM analysis revealed no significant differences between the two groups regarding in-hospital and 6-week mortality, overall post-endoscopic rebleeding, 5-day rebleeding, 6-week rebleeding, and rebleeding occurring beyond 180 days. In a subgroup analysis of patients presenting with hematemesis, those in the <24-hour group demonstrated a significantly higher incidence of overall post-endoscopic rebleeding (50.4% vs. 37.9%, P=0.015) and rebleeding beyond 180 days post-treatment (29.9% vs. 19.3%, P=0.014) compared to the ≥24h group. Additionally, in the subgroup analysis of patients classified as Child-Pugh class B, the <24-hour group showed a significantly elevated rate of overall post-endoscopic rebleeding compared to the ≥24-hour group (50.0% vs. 38.2%, P=0.026). This rate was also significantly higher in the <72-hour group compared to the ≥72-hour group (44.8% vs. 35.1%, P=0.018). Notably, the incidence of rebleeding beyond 180 days post-endoscopic therapy was higher in the <72-hour group compared to the ≥72-hour group (25.2% vs. 17.7%, P=0.029). Multivariate Cox regression analysis indicated that the timing of endoscopic therapy was not an independent risk factor for rebleeding.

In conclusion, for patients with AEGVB who can tolerate endoscopy, early endoscopic intervention may not enhance the overall prognosis.