Liver, Pancreas and Biliary Tract| Volume 51, ISSUE 7, P993-998, July 2019

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Optimal endoscopy timing according to the severity of underlying liver disease in patients with acute variceal bleeding

Published:January 29, 2019DOI:



      Current guidelines recommend endoscopic therapy to be performed within 12 h for acute variceal bleeding (AVB). However, the optimal timing of endoscopic therapy for AVB remains unclear.


      To examine the relationship between the endoscopy timing and clinical outcomes in AVB, with emphasis on liver function and endoscopy timing.


      From January 2010 to June 2017, cirrhotic patients with AVB confirmed by endoscopy were evaluated. The primary outcome was a composite of 6-week rebleeding and mortality. We stratified patients according to the MELD score.


      In 411 patients, the overall composite outcome rate was 30.9% (n = 127) at 6 week. Patients who underwent urgent endoscopy (≤12 h) had a significantly higher composite outcome than patients who underwent non-urgent endoscopy (>12 h) (34.4% vs. 19.1%; P = 0.005). Low-risk patients who underwent urgent endoscopy were more likely to reach the composite outcome (adjusted OR, 0.84 per 4 h; 95% CI, 0.73–0.98; P = 0.027). These findings persisted even after adjustment for baseline characteristics between the urgent and non-urgent groups.


      Urgent endoscopy is significantly associated with a poorer outcome in patients with AVB, especially in low-risk patients. Our result provides a treatment strategy according to the severity of underlying liver disease in patients with AVB.


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      Linked Article

      • Endoscopy in acute variceal bleeding: Not always the sooner, the better?
        Digestive and Liver DiseaseVol. 51Issue 7
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          Since the first consensus meeting on portal hypertension held in Baveno, Italy, in 1990, the statement that endoscopy should be performed as soon as possible in case of acute upper gastrointestinal bleeding in a cirrhotic patient was largely agreed upon by experts, despite limited evidence [1]. The overall severity of variceal bleeding in cirrhosis and the availability of effective endoscopic treatments argued in favour of early endoscopy according to the “the sooner, the better” strategy. Therefore, the consensus statement of Baveno VI that “endoscopy should be performed as soon as resuscitation is adequate, and preferably within 12 h of admission” appeared consistent, although some caution could appear in the ensuing comment that “endoscopic diagnosis during upper GI bleeding can be difficult when the view is obscured by blood” [2].
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