Endoscopy Timing in Acute Upper Gastrointestinal Bleeding: A Risk-Stratified Comparative Cohort

Dr. Mohit Bhatnagar, Neha Kakran, Vishal Kumar

Upper Gastrointestinal Bleeding; Endoscopy; Glasgow-Blatchford Score; Rockall Score; Rebleeding; Mortality; Timing

Optimal timing of endoscopy in acute upper gastrointestinal bleeding (UGIB) remains debated, with international guidelines recommending endoscopy within 24 hours of presentation while reserving very early endoscopy (<6 hours) for haemodynamically unstable or high-risk patients. We retrospectively reviewed 342 consecutive admissions for acute UGIB at a tertiary centre over three years, stratifying by endoscopy timing (early <6 h, standard 6-24 h, late >24 h) and by baseline risk using the Glasgow-Blatchford score (GBS). Endoscopy was performed early in 88 patients (25.7%), standard in 178 (52.0%), and late in 76 (22.2%). Glasgow-Blatchford and pre-endoscopic Rockall scores both discriminated well for need for intervention (AUC 0.87 and 0.82 respectively). Rebleeding within 30 days varied substantially by timing and risk: 14.2% in high-risk patients with late endoscopy compared with 3.8% in low-risk patients with early endoscopy. Overall 30-day mortality was 8.5%, with late endoscopy independently associated with increased mortality (adjusted OR 1.78). The findings support risk-stratified endoscopy timing, with very early endoscopy reserved for high-risk patients while standard 6-24 hour timing remains appropriate for the majority.

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