Our clinical experience in patients with acute non-variceal upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding is named to bleeding originating from the proximal ligament of Treitz to the esophagus, stomach and proximal duodenum. Despite innovations in treatment, mortality is still around 10% in acute upper gastrointestinal bleeding. Esophagogastroduodenoscopy is used in diagnosis and treatment. In our study, data such as hemodynamic findings, presentation symptoms, comorbid diseases, drugs used by patients, various laboratory parameters, re-bleeding conditions, blood transfusion needs, re-endoscopy needs, average length of stay, endoscopic bleeding findings, endoscopic hemostasis techniques, additional intervention needs of patients, inpatient mortality and 30-day mortality were studied. Such data belonged to patients who applied to our hospital with non-variceal upper gastrointestinal system bleeding or those having non-variceal upper gastrointestinal system bleeding while staying in our hospital. We aimed to evaluate these parameters, analyze them according to the duration of endoscopy and compare them with the literature Materials and Methods Through 01.02.2019 and 31.09.2021 patients applied to Ankara City Hospital with acute non-variceal upper gastrointestinal bleeding were studied. They were presented with acute non-variceal upper gastrointestinal system bleeding or those have had acute non-variceal upper gastrointestinal system bleeding during hospitalization and bleeding in those underwent esophagogastroduadenoscopy. The patients were divided into 3 groups according to the duration of endoscopy from the time they applied for upper gastrointestinal bleeding, as the first 12 hours, 12 -24 hours, and after 24 hours. The studied patients were divided into 3 groups as first 12 hours, 12-24 hours, and after 24 hours. Patients under the age of 18, patients with insufficient data, pregnant patients, those with lower GI bleeding or those with varicose bleeding and those who did not undergo endoscopy were excluded from the study. Information about the patients was obtained retrospectively from the patient files, e medulla, e pulse and hospital information system. Results In our study, 716 0ut of 821 patients with nonvariceal upper gastrointestinal bleeding and underwent endoscopy were analyzed retrospectively. The remaining 105 patients who applied with variceal bleeding were excluded from the study. 473 (66.1%) patients were males and 243(33.9%) patients were females. The mean age of the patients was 64.58±18.38 years. 63% of the patients were over 60 years of age. The most common presenting symptom of the patients (508 patients 70.8%) was melana and the most common chronic disease (357 patients 49.9%) was hypertension. The most common drug used by the patients was aspirin (226 patients 31.6%). In the endoscopy of the patients, the most common bleeding focus (342 patients 48.7%) was peptic ulcer, and erosive gastritis was the second most common (73 patients 10.2%). Duodenal ulcer was more common than gastric ulcer (167 versus 31.1% patients, 223 11.9% patients). While the endoscopic hemostasis method was applied to 187 patients (26%), the most commonly used endoscopic hemostasis technique was hemoclips in 16.1% of 87 patients. The in-hospital mortality of the patients was 14.2%, while the 30-day mortality was 3.7%. However, while there is no statistical difference between inpatient mortality and average length of stay between the first 12 hours and 12-24 hours; In the group that underwent endoscopy after 24 hours, inpatient mortality and mean length of stay were higher (p:0.001 p<0.05). There was no significant difference in 30-day mortality between the groups (p:0.14 p>0.05). In patients who underwent endoscopy in the first 12 hours, it was detected that more bleeding focus and more endoscopic hemostasis techniques were exposed (p:0.004 p<0.05), and the second control re-endoscopy was detected more in this hour interval (p:0.001 p<0.05). In addition, it was determined that the mortality rate of the patients increased as the amount of blood transfusion increased (p:0.006 p<0.05). The endoscopy performed in the first 12 hours had lower blood transfusion (p:0.000 p<0.05) and lower rebleeding rate (p:0.002 p<0.05). In our study, However, the inclusion of patients with non-variceal upper gastrointestinal system bleeding in patients hospitalized for other reasons may also have contributed to this. Conclusion In our study, the application of endoscopy within 24 hours to patients presenting with non-variceal upper GI bleeding may reduce in-hospital mortality and average length of stay. However, it was found that the application of endoscopy within the first 12 hours resulted in more control endoscopy and more exposure to endoscopic hemostasis methods. Therefore, in patients with upper gastrointestinal bleeding, performing endoscopy within 12-24 hours may require less control endoscopy and endoscopic treatment methods. Keywords: Upper gastrointestinal bleeding peptic ulcer endoscopy time mortality