Bedside endoscopy for significant acute upper gastrointestinal bleed

Acute upper gastrointestinal bleeding (AUGIB) is a frequent life-threatening scenario in everyday clinical practice. We undertook a study to assess the etiology and important clinical outcomes in patients with significant AUGIB unstable for transfer to an endoscopy suite.

This is a prospective observational study conducted between December 2019 and December 2022, including patients above the age of 16 years with a history of clinically significant AUGIB undergoing bedside endoscopy in an intensive care (ICU)/high dependency unit (HDU) setting.

Seventy patients with a mean age (SD) of 51.27 (13.45) years were included. The initial mean (SD) hemoglobin, APACHE score, SOFA score and GCS of these patients were 6.71 (2.14) g%, 20.3 (8.3), 8.28 (4.64) and 10.9 (4.68), respectively. The major causes for AUGIB were portal hypertension in 28 (40%) and peptic ulcer disease in 24 (34.2%) patients. Eight patients (19.5%) experienced rebleed. Radiological intervention was needed for three patients (4.3%) and surgery for two (2.9%) patients. Overall, 30-day mortality was 54.2%. AUGIB, per se, was the cause for mortality in only 21% of those who died. Sepsis, respiratory failure and liver failure were the factors that independently predicted 30-day mortality.

This is the first study specifically looking at the role of bedside endoscopy in AUGIB among South Asian patients. The most common etiologies of AUGIB in our cohort were portal hypertension and peptic ulcer disease. Rebleed, surgery and 30-day mortality rates were 19.5%, 2.9% and 54.2%, respectively. A majority of the deaths were due to underlying co-morbidities.