Failed endoscopic hemostasis in upper gastrointestinal bleeding
Piotr Tracz, Ingvar SverrissonAbstract
Introduction
The aim of the study was to describe the treatment of upper gastrointestinal bleeding (UGIB) and its limitations.
Methods
This was a population-based, retrospective study of all adults admitted to two hospitals and who underwent gastroscopy with a clinical suspicion of UGIB between 2018–2022 in Västmanland county, Sweden with a catchment area of 280 000. Patient charts were reviewed and bleeding sources, treatments and outcome were assessed.
Results
We identified 888 patients. Of these, 130 developed UGIB during hospitalization for other causes. The most common sources of bleeding were ulcers (43%) and varices (36%). The bleeding was endoscopically treated in 244 patients (27%).Endoscopic treatment failed in 30 patients (12%). Of these 22 needed interventional radiology (9%) and surgery was performed in 8 (3%). In-hospital mortality occurred in 31 patients (4%) and 71 died within 30 days (8%). Among 758 patients who were primarily admitted due to suspected UGIB 18 (2%) died during hospialisation and 50 (7%) died within 30 days.Of the 130 who developed UGIB during hospital stay,13 died during hospitalisation (10%), and 21 died within 30 days (16%). Rockall score among patients who died during hospitalisation was high in both groups with a median value of 9.
Discussion
Endoscopic treatment of UGIB is effective. Failed or missed endoscopic treatments were mainly related to the nature of the bleeding source or the patient`s condition. UGIB developed during hospitalization showed higher mortality.