Background: While the effectiveness of upper endoscopy has been established
for acute nonvariceal upper gastrointestinal tract hemorrhage, its optimal
timing has not been clearly defined. Early endoscopy has been advocated fo
r its ability to achieve prompt diagnosis, risk stratification, and therape
Objective: To determine whether early vs delayed endoscopy improves patient
and economic outcomes for all risk groups with nonvariceal upper gastroint
estinal tract hemorrhage.
Methods: A systematic review of 3 computerized databases (MEDLINE, HEALTHST
AR, and Cochrane Database of Systematic Reviews) was performed along with h
and searching of published abs tracts to identify English-language citation
s from 1980 to 2000.
Results: Twenty-three studies met explicit inclusion criteria. The highest-
quality study examining outcomes in low-risk patients found no significant
complications at 1-month follow-up for any outpatients managed with early e
ndoscopy. The largest randomized trial of high-risk patients showed no mort
ality benefit but a significant decrease in transfusion requirements with e
arly endoscopy. Seven of the 8 studies examining the effect of early endosc
opy on length of stay as a measure of resource utilization demonstrated a s
ignificant reduction compared with that of delayed endoscopy. However, most
included studies were found to suffer from 1 or more potentially significa
nt methodologic shortcomings.
Conclusions: The overwhelming majority of existing data suggest that early
endoscopy is safe and effective for all risk groups. The clinical and econo
mic outcomes of early endoscopy should be confirmed in additional well-desi
gned randomized controlled trials. Given the strength of the evidence, effo
rts to develop a more standardized and time-sensitive approach to acute non
variceal upper gastrointestinal tract hemorrhage should be undertaken.