Early endoscopy effective for UGIB in acute coronary syndrome patients

In patients with recent acute coronary syndrome (ACS), early endoscopy (EE) for upper gastrointestinal bleeding (UGIB) is superior to non-EE, leading to better rates of bleeding control, lower rates of rebleeding, and less need for transfusion, reports a recent study.

However, EE for UGIB appears to pose more complications for male ACS patients.

The study included 43 patients who were randomly assigned to EE (n=22) or non-EE (n=21) groups. EE patients underwent therapeutic operation within 24 hours after bleeding, while only medical treatment was offered to non-EE patients. All participants were on intravenous proton pump inhibitors (PPI).

In the intention-to-treat analysis, the failure rate of controlling haemorrhage was significantly higher in the non-EE group (23.81 percent vs 4.55 percent; p<0.001) as was the rate of 3-day rebleeding (28.57 percent vs 4.55 percent; p=0.033). The findings remained true in the per-protocol analysis.

Multivariate analysis further found that EE significantly reduced the likelihood of needing blood transfusion (odds ratio [OR], 0.13, 95 percent confidence interval [CI], 0.02–0.98).

Such therapeutic benefit did not come at the cost of safety, with mortality rates being comparable between the EE and non-EE groups. Minor and major complications likewise occurred at comparable frequencies.

Of note, however, the researchers found that men were at a significantly higher risk of minor (OR, 3.50, 95 percent CI, 1.15–10.63) and major (OR, 4.25, 95 percent CI, 1.43–12.63) complications after EE.

“To our knowledge, this study was the first multicentre RCT to evaluate the efficacy and safety of urgent endoscopy for management of acute UGIB in ACS patients. We have found that EE had higher rate of haemorrhage control, lower 3-day rebleeding rate, and lower needs for blood transfusion than PPI therapy alone,” the researchers said.