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Penaud V, Vieille T, Urbina T, Bonny V, Gabarre P, Missri L, Gasperment M, Baudel JL, Carbonell N, Beurton A, Chaibi S, Retbi A, Fartoukh M, Piton G, Guidet B, Maury E, Ait-Oufella H, Joffre J. Prediction of esophagogastroduodenoscopy therapeutic usefulness for in-ICU suspected upper gastrointestinal bleeding: the SUGIBI score study. Ann Intensive Care 2024; 14:28. [PMID: 38361004 PMCID: PMC10869326 DOI: 10.1186/s13613-024-01250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Suspected upper gastrointestinal bleeding (SUGIB) is a common issue during ICU stay. In the absence of specific guidelines on the indication and timing of esophagogastroduodenoscopy (EGD), there is substantial variability in EGD indication depending on accessibility and clinical presentation. This study aimed to investigate factors associated with the need for per-EGD hemostatic therapy and to create a score predicting therapeutic benefit of emergency bedside EGD in ICU patients with SUGIB. METHODS We conducted a retrospective study in our ICU to identify factors associated with the need for hemostatic procedure during EGD performed for SUGIB. From this observational cohort, we derived a score predicting the need for hemostasis during EGD, the SUGIBI score. This score was subsequently validated in a retrospective multicenter cohort. RESULTS Two hundred fifty-five patients not primarily admitted for GI bleeding who underwent a bedside EGD for SUGIB during their ICU stay were analyzed. The preeminent EGD indication were anemia (79%), melena (19%), shock (14%), and hematemesis (13%). EGD was normal in 24.7% of cases, while primary lesions reported were ulcers (23.1%), esophagitis (18.8%), and gastritis (12.5%). Only 12.9% of patients underwent hemostatic endotherapy during EGD. A SUGIBI score < 4 had a negative predictive value of 95% (91-99) for hemostatic endotherapy [AUC of 0.81; 0.75-0.91 (p < 0.0001)]. The SUGIBI score for predicting the need for an EGD-guided hemostatic procedure was next validated in a multicenter cohort with an AUC of 0.75 (0.66-0.85) (p < 0.0001), a score < 4 having a negative predictive value of 95% (92-97). CONCLUSIONS Our study shows that the therapeutic usefulness of bedside emergency EGD for SUGIB in critically ill patients is limited to a minority of patients. The SUGIBI score should help clinicians stratify the probability of a therapeutic EGD.
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Affiliation(s)
- Victor Penaud
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Thibault Vieille
- Intensive Care Unit, Besançon University Hospital, 25000, Besançon, France
| | - Tomas Urbina
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Vincent Bonny
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Paul Gabarre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Louai Missri
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Maxime Gasperment
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Jean-Luc Baudel
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Nicolas Carbonell
- Gastroenterology Department, AP-HP, Hôpital Saint-Antoine, Sorbonne University, 75012, Paris, France
| | - Alexandra Beurton
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, 75020, Paris, France
| | - Sayma Chaibi
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Aurélia Retbi
- Département d'Information Médicale, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Muriel Fartoukh
- Intensive Care Unit, Tenon University Hospital, APHP, Sorbonne University, 75020, Paris, France
| | - Gaël Piton
- Intensive Care Unit, Besançon University Hospital, 25000, Besançon, France
| | - Bertrand Guidet
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Inserm U1136, Sorbonne University, Paris, France
| | - Eric Maury
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
| | - Hafid Ait-Oufella
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France
- Paris Cardiovascular Research Center, Inserm U970, Paris Center University, Paris, France
| | - Jérémie Joffre
- Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
- Centre de Recherche Saint-Antoine, Inserm UMRS-938, Sorbonne University, Paris, France.
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Sankar A, Ladha KS, Grover SC, Jogendran R, Tamming D, Razak F, Verma AA. Predictors of ICU admission associated with gastrointestinal endoscopy in medical inpatients: A retrospective cohort study. J Gastroenterol Hepatol 2022; 37:2074-2082. [PMID: 35869833 DOI: 10.1111/jgh.15969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Gastrointestinal (GI) endoscopic procedures are commonly performed in medical inpatients. Limited prior research has examined factors associated with intensive care unit (ICU) admission after GI endoscopy in medical inpatients. METHODS This retrospective cohort study was conducted using routinely-collected clinical and administrative data from all general medicine hospitalizations at five academic hospitals in Toronto, Canada between 2010 and 2020. We describe ICU admission and death within 48 h of GI endoscopy in medical inpatients. We examined adjusted associations of patient and procedural factors with ICU admission or death using multivariable logistic regression. RESULTS Among 18 290 medical inpatients who underwent endoscopy, 900 (4.9%) required ICU admission or died within 48 h of endoscopy. Following risk adjustment, ICU admission or death were associated with the following procedural factors: endoscopy on the day of hospital admission (aOR 3.16 [2.38-4.21]) or 1 day after admission (aOR 1.92 [1.51-2.44]) and esophagogastroduodenoscopy (EGD) procedures; and the following patient factors: Charlson comorbidity index of two (aOR 1.38 [1.05-1.81]) or three or greater (aOR 1.84 [1.47-2.29]), older age, male sex, lower hemoglobin prior to endoscopy, increased creatinine prior to endoscopy, an admitting diagnosis of liver disease and certain medications (antiplatelet agents and corticosteroids). CONCLUSIONS ICU admission or death after endoscopy was associated with procedural factors such as EGD and timing of endoscopy, and patient factors indicative of acute illness and greater comorbidity. These findings can contribute to improved triage and monitoring for patients requiring inpatient endoscopy.
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Affiliation(s)
- Ashwin Sankar
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Karim S Ladha
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Samir C Grover
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Division of Gastroenterology, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rohit Jogendran
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel Tamming
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Fahad Razak
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Amol A Verma
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Kwack WG. Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e27028. [PMID: 34449479 PMCID: PMC8389866 DOI: 10.1097/md.0000000000027028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/07/2021] [Indexed: 01/04/2023] Open
Abstract
Esophagogastroduodenoscopy (EGD) is a useful procedure performed for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend EGD implementation in intensive care unit (ICU) patients with suspected GI bleeding. The objective of this study was to compare the clinical effectiveness of EGD in critically ill patients who are using high-dose proton pump inhibitor (PPI) for suspected GI bleeding.We retrospectively analyzed ICU patients using high-dose PPI for suspected GI bleeding from January 2012 to September 2020. Major cases of GI bleeding, such as those with hematemesis and hematochezia, were excluded, and 1:1 propensity score matching was performed. The change in hemoglobin level, requirement of red blood cell transfusion, re-suspected bleeding event, length of ICU stay, and ICU mortality were compared between the EGD and non-EGD groups.Of the 174 subjects included, 52 patients underwent EGD within 24 hours of PPI administration. In the EGD group, 22 (42.3%) patients showed normal findings, while esophagitis and gastritis were most common abnormal finding (n = 11, 21.2%), and 14 patients (26.9%) underwent a hemostatic procedure. While comparing the 2 groups, the EGD group required a higher amount of red blood cell transfusion (packs) than the non-EGD group for a week (3.04 ± 0.44 vs 2.07 ± 0.25, P = .01). There was no significant difference in the change in hemoglobin level after 1 week (P = .15). After propensity score matching, the EGD group showed similar the requirement of red blood cell transfusion and change in hemoglobin level for a week (P = .52, P = .97, respectively). In analyses for all patients and propensity score matched patients, there was no statistically significant difference in term of re-suspected bleeding event rate, duration of ICU stay, and ICU mortality. However, re-suspected bleeding event rate and ICU mortality were lower trend in the EGD group than the non-EGD group.This study showed that EGD had no definite clinical benefit in ICU patients using high-dose PPI for suspected GI bleeding and aggressive EGD is not necessarily recommended. However, it is necessary to consider EGD in patients who are tolerant.
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Duboc H, Issoufaly T, Soliman H, Sztrymf B, Prat D, Le Meur M, Laissi M, Berquier G, Dreyfuss D, Coffin B, Ricard JD, Messika J. Are bedside colonoscopies performed in intensive care unit really useful? J Crit Care 2021; 63:56-61. [PMID: 33618283 DOI: 10.1016/j.jcrc.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Effectiveness of bedside Colonoscopies in Intensive Care Unit (CICU) might be limited by the poor quality of colonic preparation, and their feasibility. We sought to describe the indications and the profitability of CICU. METHODS Retrospective, bicenter observational study (2004-2015) in unselected critically ill patients. We questioned the clinical profitability of CICU, according to its indications and preparation. RESULTS One hundred and eleven CICU were performed in 84 patients (sex ratio 1.4, 49 M/35F; age 72.9 years [61.7-84.7]), for lower gastro-intestinal bleeding in 67 patients (LGIB, 60.3%) and for other causes in 44 (39.6%). The profitability was more frequent when CICU was performed for another reason than LGIB (75% vs 28.3%; p < 0.0001). Preparation was good in 47 procedures (42.3%) and allowed 33 complete CICU (29.7%). Fifty-six CICU (50.4%) were performed as a 2nd investigation after a contrast enhanced computed tomography. Three CICU were complicated by 3 hemodynamic and 2 respiratory failures, but none of them were fatal. CONCLUSIONS CICU is clinically useful in half of cases, in the diagnostic and the therapeutic management of critically ill patients. Its profitability is close to scheduled colonoscopies and superior in non-lower gastro-intestinal bleeding indications.
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Affiliation(s)
- Henri Duboc
- Université de Paris, CRI Inserm UMRS 1149, IAME Inserm UMR 1137, PHERE UMRS 1152, F-75018 Paris, France; AP-HP, Hopital Louis Mourier, DMU ESPRIT, Department of Gastroenterology, F-92700 Colombes, France
| | - Tazime Issoufaly
- Université de Paris, CRI Inserm UMRS 1149, IAME Inserm UMR 1137, PHERE UMRS 1152, F-75018 Paris, France; APHP, Hôpital Louis Mourier, DMU ESPRIT, Intensive Care Unit, F-92700 Colombes, France
| | - Heithem Soliman
- AP-HP, Hopital Louis Mourier, DMU ESPRIT, Department of Gastroenterology, F-92700 Colombes, France
| | - Benjamin Sztrymf
- APHP, Hôpital Antoine Béclère, Intensive Care Unit, Université Paris-Saclay, Paris, France
| | - Dominique Prat
- APHP, Hôpital Antoine Béclère, Intensive Care Unit, Université Paris-Saclay, Paris, France
| | - Matthieu Le Meur
- APHP, Hôpital Louis Mourier, DMU ESPRIT, Intensive Care Unit, F-92700 Colombes, France
| | - Mohammed Laissi
- APHP, Hôpital Louis Mourier, DMU ESPRIT, Intensive Care Unit, F-92700 Colombes, France
| | - Guillaume Berquier
- APHP, Hôpital Louis Mourier, DMU ESPRIT, Intensive Care Unit, F-92700 Colombes, France
| | - Didier Dreyfuss
- Université de Paris, CRI Inserm UMRS 1149, IAME Inserm UMR 1137, PHERE UMRS 1152, F-75018 Paris, France; APHP, Hôpital Louis Mourier, DMU ESPRIT, Intensive Care Unit, F-92700 Colombes, France
| | - Benoit Coffin
- Université de Paris, CRI Inserm UMRS 1149, IAME Inserm UMR 1137, PHERE UMRS 1152, F-75018 Paris, France; AP-HP, Hopital Louis Mourier, DMU ESPRIT, Department of Gastroenterology, F-92700 Colombes, France
| | - Jean-Damien Ricard
- Université de Paris, CRI Inserm UMRS 1149, IAME Inserm UMR 1137, PHERE UMRS 1152, F-75018 Paris, France; APHP, Hôpital Louis Mourier, DMU ESPRIT, Intensive Care Unit, F-92700 Colombes, France
| | - Jonathan Messika
- Université de Paris, CRI Inserm UMRS 1149, IAME Inserm UMR 1137, PHERE UMRS 1152, F-75018 Paris, France; APHP, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, F-75018 Paris, France.
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Jung K, Moon W. Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review. World J Gastrointest Endosc 2019; 11:68-83. [PMID: 30788026 PMCID: PMC6379746 DOI: 10.4253/wjge.v11.i2.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/02/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.
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Affiliation(s)
- Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea
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