Acute upper gastrointestinal bleeding due to portal hypertension in children: What is the best timing of endoscopy?

Abstract

OBJECTIVE\nTo compare initial clinical/laboratory parameters and outcomes of mortality/rebleeding of endoscopy performed <12\xa0h(early UGIE) versus endoscopy performed after 12-24h(late UGIE) of ED admission in children with acute upper gastrointestinal bleeding(AUGIB) due to portal hypertension.\n\n\nMETHODS\nThis is a retrospective cohort study. From January 2010 to July 2017, medical records of all children admitted to a tertiary care hospital with AUGIB due to portal hypertension were reviewed until 60 days after ED admission.\n\n\nRESULTS\nA total of 98 ED admissions occurred from 73 patients. Rebleeding was identified in 8/98(8%) episodes, and 9 deaths were observed. UGIE was performed in 92(94%) episodes, and 53(58%) of them occurred within 12\xa0h of ED admission. Episodes with early UGIE and late UGIE were similar in terms of history/complaints/laboratory data at admission, chronic liver disease associated, AUGIB duration, and initial management. No statistically significant associations were found between early UGIE and the outcomes of death/rebleeding and prevalence of endoscopic hemostatic treatment (band ligation or sclerotherapy) compared to late UGIE. In the multivariable logistic regression model, the endoscopic hemostatic treatment showed a negative association with early UGIE(OR=0.33;95%CI=0.1-0.9;p\xa0=\xa00.04).\n\n\nCONCLUSIONS\nThis study suggests that in pediatric patients with AUGIB and portal hypertension, UGIE may be performed after 12-24\xa0h without harm to the patient, facilitating better initial clinical stabilization/treatment and optimization of resources.