6/30/23, 2:23 AM Timing of endoscopy for AUGB Pathway Feedback Search Clinical Topics Home Studies Timing of endoscopy for AUGB Timing of endoscopy for AUGB Disease Disease Non-variceal upper gastrointesti Variceal hemorrhage Trial question What is the role of urgent endoscopy in patients with acute upper gastrointestinal bleeding who are at high risk for further bleeding or death? Study design Single center Open label RCT Population Characteristics of study participants 37.0% female N = 516 63.0% male 516 patients (191 female, 325 male) Inclusion criteria: patients with overt signs of acute upper gastrointestinal bleeding and a Glasgow-Blatchford score 12 Key exclusion criteria: continued shock despite initial volume resuscitation, age < 18 years, unable to provide written informed consent, pregnant or lactating women, moribund from terminal illnesses Interventions N=258 urgent-endoscopy (endoscopy within 6 hours of gastroenterology consultation) N=258 early-endoscopy (endoscopy between 6 and 24 hours after gastroenterology consultation) https://web.pathway.md/studies/recySAXe7DUlbYPzI 1/2 6/30/23, 2:23 AM Timing of endoscopy for AUGB Pathway Primary outcome Death from any cause at 30 days 8.9 % 8.9 6.7 % 6.6 4.5 % 2.2 % No significant difference 0.0 % Urgent-endoscopy Early-endoscopy No significant difference in death from any cause at 30 days (8.9% vs. 6.6%; HR 1.35, 95% CI 0.72 to 2.54) Secondary outcomes No significant difference in the rate of further bleeding within 30 days (10.9% vs. 7.8%; HR 1.46, 95% CI 0.83 to 2.58) No significant difference in ICU admission (1.6% vs. 1.2%; HR 1.33, 95% CI 0.3 to 5.9) Borderline significant increase in endoscopic hemostatic treatment during initial endoscopy (60.1% vs. 48.4%; HR 1.24, 95% CI 1.06 to 1.46) Safety outcomes No significant differences in persistent bleeding, recurrent bleeding, fatal and nonfatal adverse events. Significant difference in ulcers with active bleeding or visible vessels (66.4% vs. 47.8%). Conclusion In patients with overt signs of acute upper gastrointestinal bleeding and a Glasgow-Blatchford score 12, urgent-endoscopy was not superior to early-endoscopy with respect to death from any cause at 30 days. Reference James Y W Lau, Yuanyuan Yu, Raymond S Y Tang et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. Reply. N Engl J Med. 2020 Apr 2;382(14):1299-1308. Open reference URL https://web.pathway.md/studies/recySAXe7DUlbYPzI 2/2