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Emergency endoscopy for acute gastrointestinal bleeding: P rognostic value of endoscopic hemostasis and the AIMS65 score in J apanese patients
Author(s) -
Nakamura Shotaro,
Matsumoto Takayuki,
Sugimori Hiroshi,
Esaki Motohiro,
Kitazono Takanari,
Hashizume Makoto
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12187
Subject(s) - medicine , hemostasis , endoscopy , gastroenterology , blood transfusion , malignancy , gastric antral vascular ectasia , gastrointestinal bleeding , upper gastrointestinal bleeding , surgery , esophagogastroduodenoscopy , varices , argon plasma coagulation , cirrhosis
Background and Aim To evaluate the prognostic factors, including risk scores ( G lasgow‐ B latchford score and AIMS65 ) in patients with acute upper or lower gastrointestinal bleeding. Methods The medical records of patients who had undergone emergency gastrointestinal endoscopy for suspected gastrointestinal bleeding during the past 5 years were retrospectively analyzed. Results A total of 232 endoscopies (130 esophagogastroduodenoscopies, 102 colonoscopies) for 192 patients met the inclusion criteria. Median age was 66 years, and 64% of patients were males. Endoscopy identified causes for bleeding in 173 patients (post‐endoscopic interventions for neoplastic lesions in 36 cases, colonic diverticula in 34, gastroduodenal ulcers in 29, gastric erosions in 15, vascular ectasia in 14, post‐biopsy bleeding in 13, malignant tumors in 10, inflammatory conditions in nine, esophagogastric varices in five, M allory‐ W eiss tears in four, nasalbleeding in three, and injury by swallowed blister pack in one), whereas the source of bleeding remained obscure in 19 patients. Blood transfusion was given in 97 patients (51%), and 97 (51%) underwent endoscopic hemostasis. During the follow‐up period, 49 patients (26%) experienced rebleeding, seven of whom were treated by interventional radiology. Thirty‐nine patients (20%) died as a result of various diseases. The probabilities of overall survival ( OS ) after 3 and 5 years were 71% and 67%, respectively. Cox multivariate analysis revealed blood transfusion, co‐existing malignancy, absence of endoscopic hemostasis, and high AIMS65 score to be independent prognostic factors for poor OS . Conclusion The AIMS65 score is useful for predicting the prognosis of patients with acute gastrointestinal bleeding.