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Abstract：
BACKGROUND: The optimal timing of endoscopy in liver cirrhosis with acute variceal bleeding (AVB) remains controversial in current guidelines and studies.
METHODS: Consecutive patients with liver cirrhosis and AVB were screened. The timing of endoscopy was calculated from the last presentation of AVB or the admission to endoscopy. Early endoscopy was defined as the interval < 12 h, < 24 h, or < 48 h. A 1:1 propensity score matching (PSM) analysis was performed. Five-day failure to control bleeding and in-hospital mortality were evaluated.
RESULTS: Overall, 534 patients were included. When the timing of endoscopy was calculated from the last presentation of AVB, PSM analysis demonstrated that the rate of 5-day failure to control bleeding was significantly higher in early endoscopy group defined as < 48 h (9.7% versus 2.4%, P = 0.009), but not < 12 h (8.7% versus 6.5%, P = 1.000) or < 24 h (13.4% versus 6.2%, P = 0.091), and that the in-hospital mortality was not significantly different between early and delayed endoscopy groups (< 12 h: 6.5% versus 4.3%, P = 1.000; <24 h: 4.1% versus 3.1%, P = 1.000; <48 h: 3.0% versus 2.4%, P = 1.000). When the timing of endoscopy was calculated from the admission, PSM analyses did not demonstrate any significant difference in the rate of 5-day failure to control bleeding (< 12 h: 4.8% versus 12.7%, P = 0.205; <24 h: 5.2% versus 7.7%, P = 0.355; <48 h: 4.5% versus 6.0%, P = 0.501) or in-hospital mortality (< 12 h: 4.8% versus 4.8%, P = 1.000; <24 h: 3.9% versus 2.6%, P = 0.750; <48 h: 2.0% versus 2.5%, P = 1.000) between early and delayed endoscopy groups.
CONCLUSIONS: Our study could not support any significant association of timing of endoscopy with cirrhotic patients with AVB.
METHODS: Consecutive patients with liver cirrhosis and AVB were screened. The timing of endoscopy was calculated from the last presentation of AVB or the admission to endoscopy. Early endoscopy was defined as the interval < 12 h, < 24 h, or < 48 h. A 1:1 propensity score matching (PSM) analysis was performed. Five-day failure to control bleeding and in-hospital mortality were evaluated.
RESULTS: Overall, 534 patients were included. When the timing of endoscopy was calculated from the last presentation of AVB, PSM analysis demonstrated that the rate of 5-day failure to control bleeding was significantly higher in early endoscopy group defined as < 48 h (9.7% versus 2.4%, P = 0.009), but not < 12 h (8.7% versus 6.5%, P = 1.000) or < 24 h (13.4% versus 6.2%, P = 0.091), and that the in-hospital mortality was not significantly different between early and delayed endoscopy groups (< 12 h: 6.5% versus 4.3%, P = 1.000; <24 h: 4.1% versus 3.1%, P = 1.000; <48 h: 3.0% versus 2.4%, P = 1.000). When the timing of endoscopy was calculated from the admission, PSM analyses did not demonstrate any significant difference in the rate of 5-day failure to control bleeding (< 12 h: 4.8% versus 12.7%, P = 0.205; <24 h: 5.2% versus 7.7%, P = 0.355; <48 h: 4.5% versus 6.0%, P = 0.501) or in-hospital mortality (< 12 h: 4.8% versus 4.8%, P = 1.000; <24 h: 3.9% versus 2.6%, P = 0.750; <48 h: 2.0% versus 2.5%, P = 1.000) between early and delayed endoscopy groups.
CONCLUSIONS: Our study could not support any significant association of timing of endoscopy with cirrhotic patients with AVB.
摘要：
背景：在目前的指南和研究中，肝硬化急性静脉曲张破裂出血（AVB）的最佳内镜检查时机仍存在争议。
方法：连续筛选肝硬化和AVB患者。内窥镜检查的时间是从最后一次出现AVB或接受内窥镜检查开始计算的。早期内窥镜检查定义为间隔<12小时，<24小时,或<48小时。进行1:1倾向评分匹配(PSM)分析。评估了五天未能控制出血和院内死亡率。
结果：总体而言，纳入534例患者。当内窥镜检查的时间从最后一次AVB的出现计算时，PSM分析表明，在定义为<48h的早期内窥镜检查组中，5天出血失败的发生率明显更高（9.7％对2.4％，P=0.009),但不<12小时(8.7%对6.5%，P=1.000)或<24小时(13.4%对6.2%，P=0.091),早期和延迟内窥镜检查组的住院死亡率没有显着差异（<12h：6.5％对4.3％，P=1.000；<24小时：4.1%对3.1%，P=1.000；<48小时：3.0%对2.4%，P=1.000)。当从入院开始计算内窥镜检查的时间时，PSM分析显示，5天未能控制出血的发生率没有任何显着差异（<12h：4.8％对12.7％，P=0.205；<24小时：5.2%对7.7%，P=0.355；<48h：4.5%对6.0%，P=0.501）或住院死亡率（<12小时：4.8%对4.8%，P=1.000；<24小时：3.9%对2.6%，P=0.750；<48h：2.0%对2.5%，早期和延迟内镜组之间的P=1.000）。
结论：我们的研究不能支持胃镜检查时机与肝硬化AVB患者的任何显著关联。
方法：连续筛选肝硬化和AVB患者。内窥镜检查的时间是从最后一次出现AVB或接受内窥镜检查开始计算的。早期内窥镜检查定义为间隔<12小时，<24小时,或<48小时。进行1:1倾向评分匹配(PSM)分析。评估了五天未能控制出血和院内死亡率。
结果：总体而言，纳入534例患者。当内窥镜检查的时间从最后一次AVB的出现计算时，PSM分析表明，在定义为<48h的早期内窥镜检查组中，5天出血失败的发生率明显更高（9.7％对2.4％，P=0.009),但不<12小时(8.7%对6.5%，P=1.000)或<24小时(13.4%对6.2%，P=0.091),早期和延迟内窥镜检查组的住院死亡率没有显着差异（<12h：6.5％对4.3％，P=1.000；<24小时：4.1%对3.1%，P=1.000；<48小时：3.0%对2.4%，P=1.000)。当从入院开始计算内窥镜检查的时间时，PSM分析显示，5天未能控制出血的发生率没有任何显着差异（<12h：4.8％对12.7％，P=0.205；<24小时：5.2%对7.7%，P=0.355；<48h：4.5%对6.0%，P=0.501）或住院死亡率（<12小时：4.8%对4.8%，P=1.000；<24小时：3.9%对2.6%，P=0.750；<48h：2.0%对2.5%，早期和延迟内镜组之间的P=1.000）。
结论：我们的研究不能支持胃镜检查时机与肝硬化AVB患者的任何显著关联。
