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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 6, Pages 301-304
http://dx.doi.org/10.1155/2014/245386
Original Article

Can the Presence of Endoscopic High-Risk Stigmata be Bredicted before Endoscopy? A Multivariable Analysis Using the RUGBE Database

Yen-I Chen,1 Jonathan Wyse,1 Alan Barkun,1,2 Marc Bardou,3,4 Ian M Gralnek,5 and Myriam Martel1

1Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Québec, Canada
2Departments of Epidemiology and Biostatistics, and Occupational Health, McGill University Health Centre, McGill University, Montréal, Québec, Canada
3INSERM-Centre d’Investigations Cliniques Plurithématique 803 (CIC-P 803), CHU du Bocage Dijon, France
4Service d’hépato-gastroentérologie, CHU du Bocage; Dijon, France
5Department of Gastroenterology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Received 27 January 2014; Accepted 17 February 2014

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Many aspects in the management of acute upper gastrointestinal bleeding rely on pre-esophagogastroduodenoscopy (EGD) stratification of patients likely to exhibit high-risk stigmata (HRS); however, data predicting the presence of HRS are lacking.

OBJECTIVE: To determine clinical and laboratory predictors of HRS at the index EGD in patients presenting with acute upper gastrointestinal bleeding using retrospective data from a validated national database – the Canadian Registry in Upper Gastrointestinal Bleeding and Endoscopy registry.

METHODS: Relevant clinical and laboratory parameters were evaluated. HRS was defined as spurting, oozing, nonbleeding visible vessel or adherent clot after vigorous irrigation. Multivariable modelling was used to identify predictors of HRS including age, sex, hematemesis, use of antiplatelet agents, American Society of Anesthesiologists (ASA) classification, nasogastric tube aspirate, hemoglobin level and elapsed time from the onset of bleeding to EGD.

RESULTS: Of the 1677 patients (mean [± SD] age 66.2±16.8 years; 38.3% female), 28.7% had hematemesis, 57.8% had an ASA score of 3 to 5, and the mean hemoglobin level was 96.8±27.3 g/L. The mean time from presentation to endoscopy was 22.2±37.5 h. The best fitting multivariable model included the following significant predictors: ASA score 3 to 5 (OR 2.16 [95% CI 1.71 to 2.74]), a shorter time to endoscopy (OR 0.99 [95% CI 0.98 to 0.99]) and a lower initial hemoglobin level (OR 0.99 [95% CI 0.99 to 0.99]).

CONCLUSION: A higher ASA score, a shorter time to endoscopy and lower initial hemoglobin level all significantly predicted the presence of endoscopic HRS. These criteria could be used to improve the optimal selection of patients requiring more urgent endoscopy.