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Related Experiment Videos

Routine early endoscopy in upper-gastrointestinal-tract bleeding: a randomized, controlled trial

W L Peterson, C C Barnett, H J Smith

    The New England Journal of Medicine
    |April 16, 1981
    PubMed
    Summary

    Routine early endoscopy offers no significant benefit for patients with upper-gastrointestinal-tract bleeding that stops during hospitalization. This study found no differences in outcomes, suggesting endoscopy should not be standard practice in such cases.

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    Area of Science:

    • Gastroenterology
    • Clinical Medicine
    • Medical Procedures

    Background:

    • Upper-gastrointestinal-tract bleeding is a common medical condition.
    • The optimal timing and necessity of endoscopic intervention for stabilized bleeding remain subjects of clinical inquiry.
    • Previous approaches often involved early endoscopy, but its routine use for all patients with cessation of bleeding has been questioned.

    Purpose of the Study:

    • To evaluate the clinical efficacy and patient outcomes associated with routine early endoscopy versus selective endoscopy in managing upper-gastrointestinal-tract bleeding that has ceased during hospitalization.
    • To determine if a strategy of no routine endoscopy impacts mortality, re-bleeding rates, or resource utilization.

    Main Methods:

    • A randomized controlled trial involving 206 patients hospitalized with upper-gastrointestinal-tract bleeding that stopped spontaneously.

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  • Patients were allocated to either a routine early endoscopy group (100 patients) or a no-routine-endoscopy group (106 patients).
  • The no-routine-endoscopy group received endoscopy only if bleeding recurred or if imaging suggested significant pathology; all patients received initial antacid treatment.

    • Main Results:

    • No statistically significant differences were observed between the routine endoscopy and no-routine-endoscopy groups regarding in-hospital mortality (11 vs. 8 deaths), bleeding recurrence (33 vs. 32 patients), transfusion requirements for recurrent bleeding (mean 7.4 vs. 6.3 units), post-recurrence mortality (8 vs. 5 deaths), or length of hospital stay.
    • Over a 12-month follow-up period, readmission rates, incidence of further gastrointestinal bleeding, hemorrhage-related deaths, and need for gastrointestinal surgery were comparable between the two groups.

    Conclusions:

    • Routine early endoscopy is not beneficial for patients experiencing upper-gastrointestinal-tract bleeding that ceases during their hospital stay.
    • A selective endoscopy approach, reserved for cases of recurrent bleeding or significant findings on imaging, appears to yield similar clinical outcomes.
    • These findings suggest a shift away from routine endoscopy in this specific patient population, potentially optimizing resource allocation and patient management.