The timing and failure factors of endoscopic treatment in patients with non-varicose upper gastrointestinal bleeding
Objective:To analyze the timing and failure factors of endoscopic treatment in patients with non-varicose upper gastrointestinal hemorrhage.Methods:Three hunred and forty patients with non-varicose upper gastrointestinal bleeding admitted to our hospital from May 2021 to May 2023 were divided into three groups ac-cording to the different time of treatment:The general data and postoperative indexes of patients in the emergency group(treatment time＜12 h,n=100),the early group(12 h≤treatment time≤24 h,n=120)and the delayed group(treatment time＞24 h,n=120)were compared.Patients were then divided into two groups according to postoperative conditions.Patients with successful hemostasis were classified as successful group(n=272),and patients with postoperative rebleeding,transfer to ICU,re-admission 30 days later,and in-hospital death were classified as failure group(n=68).LASSO regression analysis and logistic regression analysis were used to con-duct multi-factor analysis of endoscopic treatment failure.R software built a prediction model of treatment failure risk,and Bootstrap method was used to verify the model.Results:There were statistically significant differences(P＜0.05)in blood platelet(PLT),haemoglobin(Hb),blood urea nitrogen(BUN),American Society of Anes-thesiologists(ASA)＞Ⅱ,bleeding lesion diameter≥2.0 cm,endoscopic jet like bleeding,endoscopic treatment timing,length of hospital stay,intraoperative bleeding volume,blood transfusion,blood transfusion volume,and history of upper gastrointestinal bleeding between the successful and failed groups,as well as among various sub-groups within the group(emergency group,early group,delayed group).After treatment,systolic blood pressure＜90 mmHg(1 mmHg=0.133 kPa),AIMS65 score,INR,Hb,BUN and PLT indexes in the emergency group were higher than those in the other two groups,with statistical significance(P＜0.05).In addition,patients in the early group had more normal indicators,indicating the best treatment effect.LASSO and logistic regression a-nalysis showed that PLT,Hb and endoscopic treatment timing,upper gastrointestinal bleeding history,bleeding lesion diameter ≥2.0 cm,and endoscopic jet bleeding were independent risk factors for endoscopic treatment fail-ure.The area under curve,sensitivity and specificity of the nomogram model combined with the above 5 factors were 0.905,92.2％and 86.7％respectively.The calibration curve showed that the prediction probability and ref-erence probability of the model before and after verification had a good fit,and there was no statistical significance between the Hosmer-Lemeshow test results(P＞0.05),indicating a good prediction accuracy.Conclusion:Endo-scopic therapy is best performed within 12 to 24 hours.PLT,Hb and 12 h≤endoscopic treatment time≤24 h were protective factor for endoscopic treatment failure.History of upper gastrointestinal bleeding,bleeding lesion diameter ≥2.0 cm,and endoscopic jet bleeding are independent risk factors for endoscopic treatment failure,which should be closely monitored clinically.
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