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Predictive Factors for Endoscopic Visibility and Strategies for Pre-endoscopic Prokinetics Use in Patients with Upper Gastrointestinal Bleeding

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Abstract

Background

Although current guideline recommends selective use of pre-endoscopic prokinetics to increase diagnostic yield in upper gastrointestinal bleeding (UGIB) patients, no data to guide the use of these drugs are available.

Aims

We aimed to investigate predictive factors for endoscopic visibility and develop simple and useful strategies for pre-endoscopic prokinetics use in UGIB patients.

Methods

A total of 220 consecutive patients who underwent upper endoscopy for suspicious UGIB were enrolled. Patients were randomly allocated to either a training or a validation set at a 2:1 ratio. Significant parameters on univariate analysis were subsequently tested by a classification and regression tree (CART) analysis.

Results

Time to endoscopy and nasogastric aspirate findings were independently related to endoscopic visibility. The CART analysis generated algorithms proposed sequential use of time to endoscopy (≤5.2 vs. >5.2 h) and nasogastric aspirate findings (red blood or coffee rounds vs. clear aspirate) for predicting endoscopic visibility. Prediction of unacceptable visibility in the validation set produced sensitivity, specificity, positive predictive value, and negative predictive value of 75.8, 67.5, 65.8, and 77.1 %, respectively. Accurate prediction for visibility was identified in 52 of 73 patients (71.2 %).

Conclusions

Time to endoscopy and nasogastric aspirate findings were independently related to endoscopic visibility in patients with UGIB. A decision-tree model incorporating these two variables may be useful for selecting UGIB patients who benefit from pre-endoscopic prokinetics use.

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References

  1. Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90:206–210.

    CAS  PubMed  Google Scholar 

  2. van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 2003;98:1494–1499.

    Article  PubMed  Google Scholar 

  3. Loperfido S, Baldo V, Piovesana E, et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc. 2009;70:212–224.

    Article  PubMed  Google Scholar 

  4. Marmo R, Del Piano M, Rotondano G et al. Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy. Gastrointest Endosc. 2012;75:263–272, 72 e1.

  5. Adang RP, Vismans JF, Talmon JL, et al. Appropriateness of indications for diagnostic upper gastrointestinal endoscopy: association with relevant endoscopic disease. Gastrointest Endosc. 1995;42:390–397.

    Article  CAS  PubMed  Google Scholar 

  6. Jutabha R, Jensen DM. Management of upper gastrointestinal bleeding in the patient with chronic liver disease. Med Clin North Am. 1996;80:1035–1068.

    Article  CAS  PubMed  Google Scholar 

  7. Bardou M, Benhaberou-Brun D, Le Ray I, et al. Diagnosis and management of nonvariceal upper gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol. 2012;9:97–104.

    Article  CAS  PubMed  Google Scholar 

  8. DiMaio CJ, Stevens PD. Nonvariceal upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2007;17:253–272, v.

  9. Stollman NH, Putcha RV, Neustater BR, et al. The uncleared fundal pool in acute upper gastrointestinal bleeding: implications and outcomes. Gastrointest Endosc. 1997;46:324–327.

    Article  CAS  PubMed  Google Scholar 

  10. Cheng CL, Lee CS, Liu NJ, et al. Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding. Endoscopy. 2002;34:527–530.

    Article  PubMed  Google Scholar 

  11. Brullet E, Calvet X, Campo R, et al. Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer. Gastrointest Endosc. 1996;43:111–116.

    Article  CAS  PubMed  Google Scholar 

  12. Coffin B, Pocard M, Panis Y, et al. Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study. Gastrointest Endosc. 2002;56:174–179.

    Article  PubMed  Google Scholar 

  13. Frossard JL, Spahr L, Queneau PE, et al. Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Gastroenterology. 2002;123:17–23.

    Article  CAS  PubMed  Google Scholar 

  14. Carbonell N, Pauwels A, Serfaty L, et al. Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial. Am J Gastroenterol. 2006;101:1211–1215.

    Article  CAS  PubMed  Google Scholar 

  15. Altraif I, Handoo FA, Aljumah A, et al. Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial. Gastrointest Endosc. 2011;73:245–250.

    Article  PubMed  Google Scholar 

  16. Bai Y, Guo JF, Li ZS. Meta-analysis: erythromycin before endoscopy for acute upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2011;34:166–171.

    Article  CAS  PubMed  Google Scholar 

  17. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012;107:345–360; quiz 61.

  18. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–113.

    Article  PubMed  Google Scholar 

  19. Breiman L. Classification and regression trees. Wadsworth International Group: Belmont; 1984.

    Google Scholar 

  20. Lee WC. Characterizing exposure-disease association in human populations using the Lorenz curve and Gini index. Stat Med. 1997;16:729–739.

    Article  CAS  PubMed  Google Scholar 

  21. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839–843.

    Article  CAS  PubMed  Google Scholar 

  22. Camilleri M. Integrated upper gastrointestinal response to food intake. Gastroenterology. 2006;131:640–658.

    Article  CAS  PubMed  Google Scholar 

  23. Pateron D, Vicaut E, Debuc E, et al. Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Ann Emerg Med. 2011;57:582–589.

    Article  PubMed  Google Scholar 

  24. Jairath V, Barkun AN. The overall approach to the management of upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2011;21:657–670.

    Article  PubMed  Google Scholar 

  25. Corley DA, Stefan AM, Wolf M, et al. Early indicators of prognosis in upper gastrointestinal hemorrhage. Am J Gastroenterol. 1998;93:336–340.

    Article  CAS  PubMed  Google Scholar 

  26. Aljebreen AM, Fallone CA, Barkun AN. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc. 2004;59:172–178.

    Article  PubMed  Google Scholar 

  27. Huang ES, Karsan S, Kanwal F, et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74:971–980.

    Article  PubMed  Google Scholar 

  28. Lee SD, Kearney DJ. A randomized controlled trial of gastric lavage prior to endoscopy for acute upper gastrointestinal bleeding. J Clin Gastroenterol. 2004;38:861–865.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea

    Jun Uk Lim, Sunyong Kim, Jung Won Jeon, Hyun Phil Shin, Jae Myung Cha, Kwang Ro Joo & Joung Il Lee

  2. Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Korea

    Jae Jun Park & Young Hoon Youn

  3. Department of Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea

    Sung Won Jung

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  1. Jun Uk Lim
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  2. Jae Jun Park
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  3. Young Hoon Youn
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  4. Sunyong Kim
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  5. Jung Won Jeon
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  6. Sung Won Jung
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  7. Hyun Phil Shin
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  8. Jae Myung Cha
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  9. Kwang Ro Joo
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  10. Joung Il Lee
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Correspondence to Jae Jun Park.

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Lim, J.U., Park, J.J., Youn, Y.H. et al. Predictive Factors for Endoscopic Visibility and Strategies for Pre-endoscopic Prokinetics Use in Patients with Upper Gastrointestinal Bleeding. Dig Dis Sci 60, 957–965 (2015). https://doi.org/10.1007/s10620-014-3393-y

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  • DOI: https://doi.org/10.1007/s10620-014-3393-y

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