CUHK Study Finds Earlier Endoscopy Did Not Reduce Mortality in Acute Upper GI Bleeding

The best timing for endoscopy in patients with acute upper gastrointestinal bleeding remains a topic of debate. A recent study by the Faculty of Medicine at The Chinese University of Hong Kong (CU Medicine) found that urgent endoscopy within 6 hours after consultation did not result in lower mortality or reduced risk of further bleeding compared to endoscopy performed between 6 and 24 hours after consultation. This finding challenges the previous assumption that earlier endoscopy could improve treatment outcomes.

Acute upper gastrointestinal bleeding is a common medical emergency, with symptoms including hematemesis and melena. Endoscopy is crucial for identifying the source of bleeding and providing haemostatic treatment to reduce the risk of further bleeding and the need for surgery. Despite international recommendations for endoscopy within 24 hours after presentation, the optimal timing for high-risk patients was unclear.

The study, published in The New England Journal of Medicine, involved 516 high-risk patients randomly assigned to undergo endoscopy either within 6 hours or between 6 and 24 hours after consultation. Results showed no significant differences in 30-day mortality, further bleeding rates, or duration of hospitalization between the two groups.

Professor James Yun Wong Lau of CU Medicine noted that while urgent endoscopy with haemostatic treatment has been recommended, the study's findings suggest that earlier endoscopy does not improve outcomes. Additionally, acid suppression before endoscopy was found to reduce the need for endoscopic treatment by decreasing the number of ulcers with active bleeding.

The study also indicated that the quality of endoscopy performed after hours was not inferior to that performed during office hours. However, the findings may not apply to patients with persistent hypotensive shock or those with variceal bleeding, as these groups were excluded from the study.

This research was supported by the Health and Medical Research Fund of the Food and Health Bureau of the Hong Kong Special Administrative Region Government.