Study On The Value Of Gastroscopy At Different Times In The Diagnosis And Treatment On The Patients With Nonvariceal Upper Gastrointestinal Bleeding

Background and purposeAcute non variceal upper gastrointestinal bleeding（ANVUGIB）is one of the most common types of bleeding in gastroenterology.It belongs to acute,critical and severe cases.If it is not diagnosed and treated in time,the mortality is high^[1-2].When gastroscopy is performed to determine the cause and location of bleeding,endoscopic hemostasis has become the first choice for clinical treatment of the disease.However,there is still a controversy about the impact of ANVUGIB gastroscopy on clinical efficacy and the best time for gastroscopy.The purpose of this study was to further explore the relationship between gastroscopy at different times and its treatment effect in patients with ANVUGIB through meta-analysis and retrospective analysis of case data in their clinical center.Methods（1）Meta analysis:For multiple English,Chinese databases,January 2000 to March 2021,a total of 2469 documents were retrieved,and various research,extract information and data were screened according to the predetermined inclusion standard.According to the NOS bias assessment meter of the queue study,the quality of the clinical research was evaluated,and the REVMAN 5.4 was used for Meta analysis,and the effect of gastroscopy time on the efficacy of the ANVUGIB was evaluated.（2）Retrospective analysis:The clinical data of 342 ANVUGIB patients admitted to department of Gastroenterology,The First Affiliated Hospital of Harbin Medical University from January 1,2018 to December 31,2019 were retrospectively analyzed.According to the time of gastroscopy,the patients were divided into group A 232cases（within 8 hours）,group B 42 cases（8-12 hours）,and group C 68 cases（12-24hours）.The differences in outcome indicators（such as rebleeding rate,etc.）among the three groups were compared^[3].Results（1）Meta analysis:A.gastroscopy time≤8 hours vs.8-24 hours:there was no statistical significance in the detection rate of bleeding site（etiology detection rate）,active bleeding detection rate and rebleeding rate in the two groups;The gastroscope time≤8 hours is lower than the gastroscope time of 8-24 hours in terms of blood transfusion rate.B.Gastroscopy time≤24 hours vs.>24 hours:gastroscopy time≤24 hours is significantly higher than gastroscopy time>24 hours in the detection rate of bleeding site（etiology detection rate）,active bleeding detection rate and hemostasis success rate,and lower than gastroscopy time>24 hours in blood transfusion rate and rebleeding rate;However,the mortality was higher than that of gastroscopy for more than 24 hours.（2）Retrospective analysis:the detection rate of bleeding site in group A was higher than that in group B and group C,but the difference was not statistically significant（97.84%vs 95.24%and 94.18%,P>0.05）;There was no significant difference in the detection rate of active bleeding,hemostasis success rate,rebleeding rate,ICU transfer demand and blood transfusion rate compared with group B and group C.The prolongation of hospitalization time was significantly higher than that in group B and group C,and the difference was statistically significant.Conclusion:For patients with ANVUGIB,gastroscopy within 24 hours after bleeding is conducive to the recovery and prognosis of patients,and gastroscopy time≤8 hours is more conducive to reduce the blood transfusion rate of patients.Gastroscopy within 8-12hours can shorten the hospitalization time of patients;However,gastroscopy within 24hours after bleeding can increase the risk of mortality.Therefore,the correlation between the timing of early gastroscopy and the prognosis of patients is worthy of further discussion in clinic.ConclusionsFor patients with ANVUGIB,gastroscopy within 24 hours after bleeding is beneficial to the recovery and prognosis of patients,and gastroscopy time≤8 hours is more beneficial to reduce the blood transfusion rate and shorten the hospital stay;However,gastroscopy within 24 hours after bleeding can increase the risk of mortality.Therefore,the correlation between the timing of early gastroscopy and the prognosis of patients is worthy of further discussion in clinic.