Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

Table 1 Distribution of 272 patients with acute non-variceal upper GI bleeding according to age, sex, and other selected covariates

Covariates		n (%)
Sex, male		186 (68.4)
Mean age (yr)		67.4±15.8
<40		19 (7.0)
40–49		24 (8.8)
50–59		26 (9.6)
60–69		51 (18.8)
70–79		88 (32.4)
≥ 80		64 (23.5)
Shock grade1: 0		213 (78.3)
1		35 (12.8)
2		24 (8.8)
Comorbidities: cardiovascular		73 (26.8)
Neoplastic		30 (11.0)
Hepatic		26 (9.5)
Nephropathic		17 (6.2)
Multiple		48 (17.6)
Others		37 (13.3)
Main symptom at presentation2: hematemesis		114 (42.0)
Melena		89 (33.0)
Anemia		69 (25.0)
Epigastric pain		19 (7.0)
Time of endoscopy: 8.00 a.m.–5.00 a.m.		221 (81.0)
5.00 p.m.–8.00 a.m.		51 (19.0)
Rockall score: 1–3		58 (21.3)
4–6		146 (53.7)
>6		68 (25.0)
Ulcer location: esophagus		21 (7.7)
Stomach		121 (44.5)
Duodenum		130 (47.8)
Ulcer size3: <20 mm		152 (68.5)
≥20 mm		70 (31.5)
Forrest classification: 1A		6 (2.2)
1B		59 (21.7)
2A		19 (7.0)
2B		63 (23.2)
2C		125 (45.9)
Transfusion requirements before
endoscopy: (number of blood units)	0	229 (84.2)
	1–4	37 (13.6)
	≥5	6 (2.2)

¹Shock grade: grade 0 = no shock signs (systolic BP >100, pulse <100), grade 1 = tachycardia (systolic BP >100, pulse >100), grade 2 = hypotension (systolic BP <100, pulse >100).

²The sum of main symptoms is higher than the number of patients as some patients had more than one main symptom at presentation.

³The sum does not add up to the total because of some missing values.

Table 2 Rebleeding rate according to age, sex, Rockall score, Forrest’s classification, ulcer size, operator’s experience, and time of endoscopy

	Total NO. of patients	Rebleeding rate		P
Age (yr)
<65	88	8	9.1% (A)	0.046	A vs B
65-74	75	15	20.0% (B)	0.370	B vs C
> 74	109	28	25.7% (C)	0.003	A vs C
Sex
Males	186	36	19.4%	0.707
Females	86	15	17.4%
Rockall score
1–4	92	6	6.5% (A)	0.016	A vs B
5–6	112	20	17.8% (B)	0.005	B vs C
>6	68	25	36.7% (C)	<0.001	A vs C
Forrest’s classification
IA–IB	65	9	13.8% (A)	0.001	A vs B
IIA–IIB	82	33	40.2% (B)	<0.001	B vs C
IIIC	125	9	7.2% (C)	0.138	A vs C
Ulcer size a
< 20 mm	152	24	15.8%	0.079
≥ 20 mm	70	18	25.7%
Surgeon’s experience
High	214	29	13.6%	< 0.001
Low	58	22	37.9%
Time of endoscopy
Working hours	221	41	18.5 %	0.862
Out of working	51	10	19.6%
hours

¹ The sum does not add up to the total because of some missing values.

Table 3 Distribution of patients by experience of endoscopists and time period of treatment, according to selected outcomes. Univariate analysis.

		Experience of endoscopist			Time period
		High n (%)	Low n (%)	P	8AM-5PM n (%)	5PM-8AM n (%)	P
					n	n
Rebleeding
	Yes	29 (58.9)	22 (43.1)	< 0.001	41 (80.4)	10 (19.6)	0.862
	No	185 (83.7)	36 (16.3)		180 (81.5)	41 (18.6)
N. of blood units transfused after endoscopy
	≥ 3	14 (48.3)	15 (51.7)	< 0.001	23 (79.3)	6 (20.7)	0.777
	< 3	200 (82.3)	43 (17.7)		198 (81.5)	45 (18.5)
Need for Surgery
	Yes	9 (60.0)	6 (40.0)	0.069	10 (66.7)	5 (33.3)	0.137
	No	205 (79.8)	52 (20.2)		211 (82.1)	46 (17.9)
Mortality
	Death	31 (86.1)	5 (13.9)	0.242	26 (72.2)	10 (27.8)	0.136
	Alive	183 (77.5)	53 (22.5)		195 (82.6)	41 (17.4)
Length of hospital staying
	≥ 13 d	107 (75.9)	34 (24.1)	0.244	120 (85.1)	21 (14.9)	0.091
	< 13 d	107 (81.7)	24 (18.3)		101 (77.1)	30 (22.9)
Rockall score
	< 6	111 (83.5)	22 (16.5)	0.06	108 (81.2)	25 (18.8)	0.985
	≥ 6	103 (74.1)	36 (25.9)		113 (81.3)	26 (18.7)
Forrest’s classification

Table 4 OR and corresponding 95%CI for patients treated by less vs well experienced endoscopists and for patients treated between 5 p.m. and 8 a.m. compared to those treated between 8 a.m. and 5 p.m. according to selected outcomes

	Low vs high experience of endoscopist		8 a.m.-5 p.m. vs 5 p.m.-8 a.m. time period
	OR1 (95%CI)	OR2 (95%CI)	OR3 (95%CI)	OR4 (95%CI)
Rebleeding
Yes	4.47	1.33	0.94	1.40
No	(2.11-9.47)	(0.46-3.83)	(0.38-2.30)	(0.51-3.83)
Number of blood units
transfused after endoscopy
≥3	6.90	5.07	0.89	0.92
<3	(2.80-16.98)	(1.89-13.61)	(0.31-2.56)	(0.32-2.70)
Need for surgery
Yes	2.36	1.67	1.85	1.99
No	(0.74-7.50)	(0.43-6.41)	(0.54-6.37)	(0.56-7.04)
Mortality
Dead	0.47	0.64	1.96	1.92
Alive	(0.17-1.34)	(0.20-2.11)	(0.80-4.78)	(0.79-4.69)
Length of hospital stay
≥13 d	0.88	1.66	1.51	0.52
<13 d	(0.51-1.53)	(0.85-3.28)	(0.84-2.72)	(0.27-1.01)

¹Estimates from multiple logistic regression after adjustment for age, sex, Rockall and Forrest score, blood transfusion, and time period. Reference category is highly experienced endoscopists.

²As in 1 after further adjustment for appropriateness. Reference category is highly experienced endoscopists^{. 3}Estimates from multiple logistic regression after adjustment for age, sex, Rockall and Forrest score, blood transfusion,and experience of endoscopists. Reference category is 5 p.m.-8 a.m.

⁴As in 3 after further adjustment for appropriateness. Reference category is 5 p.m.-8 a.m.

Table 5 OR and corresponding 95%CI for patients cured with inappropriate and appropriate treatment according to selected outcomes

	Treatment used
	Appropriate	Inappropriate
	n (%)	n (%)	OR1 (95%CI)
Rebleeding
Yes	27 (52.9)	24 (47.1)	43.49
No	216 (97.7)	5 (2.3)	(11.29-167.60)
Number of blood units
transfused after endoscopy
≥3	21 (72.4)	8 (27.6)	2.98
<3	222 (91.4)	21 (8.6)	(0.82-10.78)
Need for surgery
Yes	11 (73.3)	4 (26.7)	2.62
No	232 (90.3)	25 (9.7)	(0.46-14.94)
Mortality
Dead	33 (91.7)	3 (8.3)	0.47
Alive	210 (88.9)	26 (11.0)	(0.10-2.25)
Length of hospital stay
≥13 d	125 (88.7)	16 (11.4)	0.60
<13 d	118 (90.1)	13 (9.9)	(0.24-1.54)

¹Estimates from multiple logistic regression after adjustment for age, sex, Rockall and Forrest score, blood transfusion, time period, and experience of endoscopists. Reference category is appropriate endoscopic treatment.