Survival and emergency surgery in upper gastrointestinal bleeding

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Medical Diagnostics

Background:

• Upper gastrointestinal bleeding (UGIB) presents significant mortality risks.
• Effective diagnostic and management strategies are crucial for improving patient survival.
• The role of early endoscopic intervention in UGIB requires ongoing evaluation.

Purpose of the Study:

• To evaluate the impact of early oesophago-gastro-duodenoscopy on survival and emergency surgical intervention rates in patients with upper gastrointestinal bleeding.
• To assess the diagnostic yield of endoscopy at different time points.
• To analyze mortality rates, particularly postoperative mortality, in relation to patient age and treatment modality.

Main Methods:

• A retrospective analysis of 277 patients hospitalized with upper gastrointestinal bleeding over a two-year period.
• Endoscopy (oesophago-gastro-duodenoscopy) was performed in 206 patients.
• Outcomes evaluated included survival, frequency of emergency surgery, and mortality rates, with a focus on variceal vs. non-variceal bleeding and patient age.

Main Results:

• Endoscopy did not show a difference in diagnostic yield based on the timing of the procedure.
• Excluding variceal bleeders, the overall mortality rate was 7.1%.
• The operative frequency was low at 11%, but postoperative mortality was high at 45.2%, predominantly in patients over 60 years old.

Conclusions:

• Early endoscopy for upper gastrointestinal bleeding is beneficial, leading to a low rate of surgical intervention without adversely affecting overall mortality.
• Conservative treatment mortality remains a challenge, especially in elderly patients.
• Endoscopic evaluation is a valuable tool in managing upper gastrointestinal bleeding, optimizing patient outcomes through reduced surgical necessity.