Effects Of Endoscopy Interfereence At Different Times On Patients With Acute Upper Gastrointestinal Bleeding

Objective: To explore the effect of endoscopy on the treatment of acute upper gastrointestinal bleeding at different times and to guide the clinical application.Methods: The clinical records of patients with acute upper gastrointestinal hemorrhage diagnosed in Affiliated Hospital of Guilin Medical University from January 2018 to October 2020 were collected retrospectively.They were divided into four groups according to different endoscopic times,There were 177 cases in group 1(6 hours≤ admission),51 cases in group2(6～12 hours),170 cases in group 3(12 ～24 hours)and 122 cases in group4(24～48 hours).A subgroup analysis was performed in each group of patients with nonvaricose hemorrhage.To record the general clinical data of four groups of patients with acute upper gastrointestinal hemorrhage or acute non-variceal upper gastrointestinal bleeding,comparison of the etiology,primary outcome endpoint(in-hospital death),secondary outcome(including rebleeding,endoscopic treatment at first endoscopic examination,surgical hemostasis,interventional hemostasis,admission to ICU、30-day readmission,number of transfusion red blood cells,transfusion red blood cell units,the length of hospital stay).Results: The most common cause of acute upper gastrointestinal bleeding was duodenal ulcer bleeding,and the second is gastric ulcer.There was no statistical difference in hospital mortality between the four groups.In group 1,5 patients(2.82%)died,one patient(1.96%)died in group 2,group 3 had 0 deaths and group 4 had 0 deaths(p =0.058).The four groups had statistical differences in rebleeding,hemostasis during the first endoscopic examination,interventional hemostasis,transfusion of red blood cells,transfusion of red blood cell units,and the length of hospital stay.The subjects were not treated by surgery.The percentage of rebleeding and interventional hemostasis in group 2 was the highest.107(60.5%)in group 1,18(35.3%)in group 2,50(29.4%)in group 3and 32(26.2%)in group 4 underwent endoscopic hemostasis during the first endoscopic examination,respectively.The percentage of patients in group 1 undergoing endoscopic hemostasis during the first endoscopic examination was relatively the highest.The percentage of erythrocytes injected was relatively low in group 1 and the number of units of red blood cells receiving blood transfusion was less than that of group 3 and group 4.The median length of hospital stay in all four groups was 6 days,but group 1 had a smaller quartile spacing.Hospital stay is relatively short in group 1.There was no significant difference in readmission between the four groups(p>0.05).The number of patients(4,2,1,0)and 30-day readmissions(0,0,2,1)were similar in the four groups.Conclusions: In patients with acute upper gastrointestinal hemorrhage,endoscopic examination within 6h can reduce the proportion of patients with red blood cells transfusion and the number of units of red blood cells;and compared with 24～48h,it can shorten the hospitalization day.Death rate,rebleeding rate and readmission rate were not different in 4groups of patients with acute upper gastrointestinal bleeding.The percentage of endoscopic hemostasis 6h was the highest in patients with acute upper gastrointestinal bleeding undergoing endoscopic examination during the first endoscopic examination.The rate of rebleeding and the percentage of interventional hemostasis treatment were the highest in patients with acute upper gastrointestinal bleeding undergoing endoscopic examination within 6～12h.