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TIMING OF ENDOSCOPY IN ACUTE VARICEAL HEMORRHAGE: IS EARLIER REALLY BETTER?

J Cheung¹, I Soo, R Bastiampillai, M Ma¹
University of Alberta, Edmonton, Alberta

AIM: Acute variceal bleeding (AVB) is a medical emergency. Since the routine use of octreotide in AVB, the practice and timing of urgent endoscopy have become quite variable. The outcome of different timing of endoscopy in acute variceal bleeding has not been evaluated.
METHODS: Patients who experienced AVB between January 2001-2006 were evaluated. Outcomes were assessed on patients who presented with a hemodynamically stable (SBP >100mmHg) AVB and grouped based on timing of endoscopy; early (within 8hrs of presentation) vs delayed (after 8hrs of presentation).
RESULTS: A total of 40 patients were studied (23 early group vs 17 delayed group). Patients in the early group underwent endoscopy after presentation at a mean of 4.1 hrs vs 23.4 hrs in the delayed group. The mean systolic blood pressure was 123 vs 119 mmHg, respectively). Patients who underwent delayed endoscopy trended to have more blood transfusions than the early endoscopy group (1.8U vs 1.3U). There were no differences in hemostasis rate, Blakemore tube insertion, in-hospital encephalopathy, post-endoscopy transfusions, renal function at day 3, TIPS insertion, length of stay or in-hospital mortality between the early and delayed group. There were no differences in baseline characteristics (age, Child-Pugh, days of symptoms, initial systolic pressure, gastric varices) between the two groups.
CONCLUSIONS: In cirrhotic patients who present with a hemodynamically stable variceal hemorrhage, delayed endoscopy more than 8hrs of presentation is not associated with increased morbidity or mortality compared to endoscopy within 8hrs.

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