Tempo de execução de endoscopia e sua relação com as características clínicas e endoscópicas de pacientes com hemorragia digestiva alta não varicosa por úlcera péptica em um hospital terciário no nordeste do Brasil
DOI:
https://doi.org/10.34119/bjhrv7n4-120Keywords:
endoscopia gastrointestinal, sangramento gastrointestinal, úlcera péptica, epidemiologia, hospitalizaçãoAbstract
Antecedentes e objetivos: O sangramento gastrointestinal alto não varicoso (SGNAV) é uma causa significativa de morbidade e mortalidade. Este estudo analisou o impacto da endoscopia digestiva alta precoce (EDA) em desfechos de pacientes com SGNAV devido à doença ulcerosa péptica (DUP) no nordeste do Brasil. Métodos: Estudo de coorte retrospectivo com dados de pacientes admitidos no Hospital Regional Norte em Sobral, Ceará, Brasil, de agosto de 2018 a julho de 2019. Incluiu 67 pacientes com SGNAV, divididos em dois grupos: EDA em menos de 12 horas (G1) e entre 12 e 48 horas (G2) após a chegada ao hospital. Resultados: 76% dos pacientes eram homens e 50,7% tinham menos de 60 anos. Houve significância entre o tempo de EDA e a necessidade de transfusão, além de uma associação com níveis de hematócrito e hemoglobina. O grupo G2 teve uma estadia hospitalar mais longa (6±5 dias) comparado ao grupo G1 (4±3 dias). A taxa de mortalidade foi de 7,4%. As características endoscópicas mostraram maior classificação de Forrest II no G1 e Forrest III no G2, sem significância. O escore de Rockall não se associou ao tempo de EDA. Conclusão: Os pacientes do grupo G2 necessitaram mais transfusões, apresentaram piores índices hematimétricos, estadias hospitalares mais longas e maior taxa de mortalidade, indicando maior necessidade de cuidados médicos e hospitalares.
References
GONZÁLEZ-GONZÁLE, J. A. et al. Nonvariceal upper gastrointestinal bleeding in elderly people: Clinical outcomes and prognostic factors. J Dig Dis. 2017;18(4):212-221. DOI: 10.1111/1751-2980.12459
ROCHA, C. T. M. et al. Hemorragia digestiva alta decorrente de varize duodenal isolada: um relato de caso e revisão de literatura. Brazilian Journal of Health Review, v. 5, n. 5, p. 19180–19199, 20 set. 2022.
BERNARDI, F. et al. Evaluation of the impact of hemotransfusion on hospitalization length and complications in patients with non-variceal upper gastrointestinal bleeding. Brazilian Journal of Health Review, v. 6, n. 6, p. 27910–27921, 15 nov. 2023.
CHANG, M. A.; SAVIDES, T. J. Endoscopic Management of Nonvariceal, Nonulcer Upper Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am. 2018;28(3):291-306. DOI: 10.1016/j.giec.2018.02.003
BARKUN, A. N. et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations from the International Consensus Group. Ann Intern Med. 2019; 171(11):805-822. DOI: 10.7326/M19-1795
LAINE, L. et et. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917. DOI: 10.14309/ajg.0000000000001245
WILKINS, T.; WHEELER, B.; CARPENTER, M. Upper Gastrointestinal Bleeding in Adults: Evaluation and Management. Am Fam Physician. 2020;101(5):294-300.
MAGHREBI, H. et al. Risk stratifying patients with non-varicosic upper gastrointestinal hemorrhage using the Glasgow-Blatchford score: A case series of 91 patients. Ann Med Surg (Lond). 2022;78:103778. DOI: 10.1016/j.amsu.2022.103778
TARGOWNIK, L. E.; FISHER, D. A.; SAINI, S. D. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334-1342. DOI: 10.1053/j.gastro.2021.12.247
ABRAHAM, N. S. et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Am J Gastroenterol. 2022;117(4):542-558. DOI: 10.14309/ajg.0000000000001627
GRALNEK, I. M. et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53(3):300-332. DOI: 10.1055/a-1369-5274
FORGERINI, M. et al. Epidemiological profile of patients with non-variceal upper gastrointestinal bleeding secondary to peptic disease in a tertiary referral brazilian hospital. Arq Gastroenterol. 2021;58(2):202-209. DOI: 10.1590/S0004-2803.202100000-36
CUSTODIO LIMA, J. Hemorragia digestiva alta não varicosa: experiência do Gastrocentro-Unicamp. Características dos pacientes idosos [master’s thesis]. [São Paulo] Universidade Estadual de Campinas; 2013, 129 p.
RUSTGI, S. D. et al. Anticoagulation does not increase risk of mortality or ICU admission in hospitalized COVID-19 patients with gastrointestinal bleeding: Results from a New York health system. Clin Res Hepatol Gastroenterol. 2021;45(3):101602.ab DOI: 10.1016/j.clinre.2020.101602
SIAU, K. et al. Variation in exposure to endoscopic haemostasis for acute upper gastrointestinal bleeding during UK gastroenterology training. Frontline Gastroenterol. 2019;11(6):436-440. DOI: 10.1136/flgastro-2019-101351
Sung JJY, Laine L, Kuipers EJ, Barkun AN. Towards personalized management for non-variceal upper gastrointestinal bleeding. Gut. 2021;70(5):818-824. DOI: 10.1136/gutjnl-2020-323846
ZHENG, N. S. et al. Trends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019. Aliment Pharmacol Ther. 2022; 56(11-12):1543-1555. DOI: 10.1111/apt.17238
STANLEY, A.; LAINE, L. Management of acute upper gastrointestinal bleeding. BMJ. 2019; 364: 1-13. DOI: 10.1136/bmj.l536
PIOPPO, L. et al. Incidence of Non-variceal Upper Gastrointestinal Bleeding Worsens Outcomes with Acute Coronary Syndrome: Result of a National Cohort. Dig Dis Sci. 2021;66(4):999-1008. DOI: 10.1007/s10620-020-06266-7
ZUBERO, E. E. Management of acute upper gastrointestinal bleeding. Ann Gastr and Dig Syst 2018; 1: 1-7.
KAWASAKI, K. et al. Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case-control study. Scand J Gastroenterol. 2017;52(9):948-953. DOI: 10.1080/00365521.2017.1328989
MACEDO SILVA, V. et al. Direct oral anticoagulants are associated with potentially bleeding lesions in suspected mid-gastrointestinal bleeding. Scand J Gastroenterol. 2022;57(4):486-492. DOI: 10.1080/00365521.2021.2014951
MELCARNE, L.; GARCÍA-IGLESIAS, P.; CALVET, X. Management of NSAID-associated peptic ulcer disease. Expert Rev Gastroenterol Hepatol. 2016;10(6):723-33. DOI: 10.1586/17474124.2016.1142872
MARMO, R. et al. Comparison of assessment tools in acute upper gastrointestinal bleeding: which one for which decision. Scand J Gastroenterol. 2022;57(1):1-7. DOI: 10.1080/00365521.2021.1976268
VENERITO, M. et al. Contribution of Helicobacter pylori infection to the risk of peptic ulcer bleeding in patients on nonsteroidal anti-inflammatory drugs, antiplatelet agents, anticoagulants, corticosteroids and selective serotonin reuptake inhibitors. Aliment Pharmacol Ther. 2018;47(11):1464-1471. DOI: 10.1111/apt.14652
GUO, C. L. T. et al. Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Gut. 2022; 71:1544–1550. DOI: 10.1136/gutjnl-2020-323054
ZHENG, Y. et al. Hospitalizations for peptic ulcer disease in China: Current features and outcomes. J Gastroenterol Hepatol. 2020;35(12):2122-2130. DOI: 10.1111/jgh.15119
ROCKALL, T. A. Risk assessment after acute upper gastrointestinal Haemorrhage. Gut. 1996; 38:316-321. DOI: 10.1136/gut.38.3.316
LAU, J. Y. W. et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med. 2020;382(14):1299-1308. DOI: 10.1056/NEJMoa1912484
KANNO, T. et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2022;1(1):CD005415. DOI: 10.1002/14651858.CD005415.pub4
MULLADY, D. K.; WANG, A. Y.; WASCHKE, K. A. AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review. Gastroenterology. 2020;159(3):1120-1128. DOI: 10.1053/j.gastro.2020.05.095
LAU, L. H. S.; SUNG, J. J. Y. Treatment of upper gastrointestinal bleeding in 2020: New techniques and outcomes. Dig Endosc. 2021;33(1):83-94. DOI: 10.1111/den.1367
