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Factors that affect visibility during endoscopic hemostasis for upper GI bleeding: a prospective study

  • Author Footnotes
    ∗ Drs Sungmo Jung and Eun Hye Kim contributed equally to this work.
    Sungmo Jung
    Footnotes
    ∗ Drs Sungmo Jung and Eun Hye Kim contributed equally to this work.
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Author Footnotes
    ∗ Drs Sungmo Jung and Eun Hye Kim contributed equally to this work.
    Eun Hye Kim
    Footnotes
    ∗ Drs Sungmo Jung and Eun Hye Kim contributed equally to this work.
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Ha Yan Kim
    Affiliations
    Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
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  • Yun Ho Roh
    Affiliations
    Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
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  • Chan Hyuk Park
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Soo Jung Park
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Hyunsoo Chung
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Beom Kyung Kim
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Hyuk Lee
    Affiliations
    Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Jae Jun Park
    Affiliations
    Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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  • Sung Pil Hong
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Jun Yong Park
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Sung Kwan Shin
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Sang Kil Lee
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Yong Chan Lee
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
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  • Jun Chul Park
    Correspondence
    Reprint requests: Jun Chul Park, MD, Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Sungmo Jung and Eun Hye Kim contributed equally to this work.
Published:March 12, 2015DOI:https://doi.org/10.1016/j.gie.2014.12.024

      Background

      Adequate visibility is an important factor for achieving successful endoscopic hemostasis for the treatment of upper GI bleeding (UGIB). The independent factors that affect visibility during endoscopic procedures have yet to be determined.

      Objective

      To determine the factors that affect endoscopic visibility and to create a model that can predict in which patients unacceptable visibility is suspected before emergent endoscopic procedures for UGIB.

      Design

      Prospective, observational study.

      Setting

      University-affiliated tertiary care hospital in South Korea.

      Patients

      A total of 121 patients admitted because of UGIB.

      Intervention

      Analysis of the visibility score of the emergency endoscopies for UGIB.

      Main Outcome Measurements

      Factors affecting the visibility score of endoscopy and a classification and regression tree (CART) model for predicting of visibility.

      Results

      The EGD time and the appearance of the nasogastric (NG) tube aspirate were independent factors that were significantly associated with visibility (EGD time, P < .001; red blood appearance in NG tube aspirate, P < .001; coffee grounds appearance of NG tube aspirate, P = .006). Based on these results, a CART model was developed by using 70 patients who had been allocated to the training set. The CART generated algorithms that proposed the use of the appearance of the NG tube aspirate and the EGD time (8.5 hours) to predict visibility. The sensitivity and specificity for predicting poor visibility were 71.4% and 86.4%, respectively.

      Conclusion

      The use of the CART model enables the prediction of which patients will have poor visibility during emergent endoscopy.

      Abbreviations:

      CART (classification and regression tree), NG (nasogastric), UGIB (upper GI bleeding)
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      References

        • Khamaysi I.
        • Gralnek I.M.
        Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.
        Best Pract Res Clin Gastroenterol. 2013; 27: 633-638
        • Hwang J.H.
        • Fisher D.A.
        • Ben-Menachem T.
        • et al.
        The role of endoscopy in the management of acute non-variceal upper GI bleeding.
        Gastrointest Endosc. 2012; 75: 1132-1138
        • Czernichow P.
        • Hochain P.
        • Nousbaum J.B.
        • et al.
        Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas.
        Eur J Gastroenterol Hepatol. 2000; 12: 175-181
        • van Leerdam M.E.
        • Vreeburg E.M.
        • Rauws E.A.
        • et al.
        Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000.
        Am J Gastroenterol. 2003; 98: 1494-1499
        • Brooks J.
        • Warburton R.
        • Beales I.L.
        Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance.
        Ther Adv Chronic Dis. 2013; 4: 206-222
        • Hearnshaw S.A.
        • Logan R.F.
        • Lowe D.
        • et al.
        Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit.
        Gut. 2010; 59: 1022-1029
        • Barkun A.N.
        • Bardou M.
        • Kuipers E.J.
        • et al.
        International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.
        Ann Intern Med. 2010; 152: 101-113
        • Sung J.J.
        • Chan F.K.
        • Chen M.
        • et al.
        Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding.
        Gut. 2011; 60: 1170-1177
        • Bardou M.
        • Benhaberou-Brun D.
        • Le Ray I.
        • et al.
        Diagnosis and management of nonvariceal upper gastrointestinal bleeding.
        Nat Rev Gastroenterol Hepatol. 2012; 9: 97-104
        • Qureshi W.
        • Adler D.G.
        • Davila R.
        • et al.
        ASGE Guideline: the role of endoscopy in the management of variceal hemorrhage, updated July 2005.
        Gastrointest Endosc. 2005; 62: 651-655
        • DiMaio C.J.
        • Stevens P.D.
        Nonvariceal upper gastrointestinal bleeding.
        Gastrointest Endosc Clin N Am. 2007; 17 (v): 253-272
        • Palmer K.
        Acute upper gastrointestinal haemorrhage.
        Br Med Bull. 2007; 83: 307-324
        • Lee S.D.
        • Kearney D.J.
        A randomized controlled trial of gastric lavage prior to endoscopy for acute upper gastrointestinal bleeding.
        J Clin Gastroenterol. 2004; 38: 861-865
        • Moloney M.
        • Wilkinson M.
        Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial.
        Gastrointest Endosc. 2000; 51: 372-374
        • Altraif I.
        • Handoo F.A.
        • Aljumah A.
        • et al.
        Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial.
        Gastrointest Endosc. 2011; 73: 245-250
        • Coffin B.
        • Pocard M.
        • Panis Y.
        • et al.
        Erythromycin improves the quality of EGD in patients with acute upper GI bleeding: a randomized controlled study.
        Gastrointest Endosc. 2002; 56: 174-179
        • Carbonell N.
        • Pauwels A.
        • Serfaty L.
        • et al.
        Erythromycin infusion prior to endoscopy for acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.
        Am J Gastroenterol. 2006; 101: 1211-1215
        • Avgerinos A.
        • Nevens F.
        • Raptis S.
        • et al.
        Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial.
        Lancet. 1997; 350: 1495-1499
        • Bai Y.
        • Guo J.F.
        • Li Z.S.
        Meta-analysis: erythromycin before endoscopy for acute upper gastrointestinal bleeding.
        Aliment Pharmacol Ther. 2011; 34: 166-171
        • Barkun A.N.
        • Bardou M.
        • Martel M.
        • et al.
        Prokinetics in acute upper GI bleeding: a meta-analysis.
        Gastrointest Endosc. 2010; 72: 1138-1145
        • Daram S.R.
        • Garretson R.
        Erythromycin is preferable to metoclopramide as a prokinetic in acute upper GI bleeding.
        Gastrointest Endosc. 2011; 74 (author reply 234-5): 234
        • Frossard J.L.
        • Spahr L.
        • Queneau P.E.
        • et al.
        Erythromycin intravenous bolus infusion in acute upper gastrointestinal bleeding: a randomized, controlled, double-blind trial.
        Gastroenterology. 2002; 123: 17-23
        • Huang E.S.
        • Karsan S.
        • Kanwal F.
        • et al.
        Impact of nasogastric lavage on outcomes in acute GI bleeding.
        Gastrointest Endosc. 2011; 74: 971-980
        • Pateron D.
        • Vicaut E.
        • Debuc E.
        • et al.
        Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial.
        Ann Emerg Med. 2011; 57: 582-589
        • Laine L.
        • Jensen D.M.
        Management of patients with ulcer bleeding.
        Am J Gastroenterol. 2012; 107 (quiz 361): 345-360
        • Rivers E.
        • Nguyen B.
        • Havstad S.
        • et al.
        Early goal-directed therapy in the treatment of severe sepsis and septic shock.
        N Engl J Med. 2001; 345: 1368-1377
        • Westaby S.
        • Kharbanda R.
        • Banning A.P.
        Cardiogenic shock in ACS. Part 1: prediction, presentation and medical therapy.
        Nat Rev Cardiol. 2012; 9: 158-171
        • Breiman L.
        • Friedman J.
        • Olshen R.
        • et al.
        Classification and regression trees.
        Wadsworth, Belmont (Calif)1984
        • de Groot N.L.
        • van Oijen M.G.
        • Kessels K.
        • et al.
        Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified?.
        Endoscopy. 2014; 46: 46-52
        • Cuellar R.E.
        • Gavaler J.S.
        • Alexander J.A.
        • et al.
        Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate.
        Arch Intern Med. 1990; 150: 1381-1384
        • Sarin N.
        • Monga N.
        • Adams P.C.
        Time to endoscopy and outcomes in upper gastrointestinal bleeding.
        Can J Gastroenterol. 2009; 23: 489-493