Upper GI bleed: Death and surgery were common

Clinical bottom line (level 2c)

  1. One in nine patients with upper GI bleed died, and one in six required surgery.
  2. One in two required 4 or more units of blood.
  3. One in eight suffered complications from investigations on therapy, but complications from endoscopy were rare (NNF = 101 for unknown) .
Silverstein et al: Gastrointestinal Endoscopy 1981; 27 (2): 73-103
Expires November 2002

The study

Outcome study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: acute hospitals, USA

2225 patients (aged 2 to 98; mean 57, 66% male) referred for evaluation and treatment of upper GI bleeding to 269 physicians (17% in hospital)

Excluded if
  • fewer than 5 patients referred by an individual physician
  • incomplete data


    • 94% had endoscopy; 77% received cimetidine and 74% antacids. 3% had a Sengstaken-Blakemore tube inserted.

    ?100% followed for ?length of hospital stay
    Outcomes studied:
  • death
  • surgery required
  • 4 or more units of blood transfused
  • complications from therapy or investigations
  • endoscopy complications

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death ?length of hospital stay 241/2225 10.83%
    (9.54% to 12.12%)    		 9
    (8 to 10)
    surgery required ?length of hospital stay 346/2225 16.36%
    (14.83% to 17.90%)    		 6
    (6 to 7)
    4 or more units of blood transfused ?length of hospital stay 981/2225 44%
    (42% to 46.2%)    		 2
    (2 to 2)
    complications from therapy or investigations ?length of hospital stay 263/2225 11.82%
    (10.47% to 13.16%)    		 8
    (8 to 10)
    endoscopy complications ?length of hospital stay 23/2320 0.99%
    (0.58% to 1.39%)    		 101
    (72 to 170)

    • Endoscopic complications: 5 patients had a perforation, 4 aspirated and 3 had haemorrhage. The other 9 complications were minor (mostly mucosal tears or medication reactions). No patient died from endoscopy

    Comments

    1. This study was performed before endoscopic therapy was common. Consequently mortality and surgery rates may be higher than today.
    2. Causes of death were underlying disease (70%), bleeding (44%), surgical complications (14%) and other causes (35%).

    Citation

    1. Silverstein FE, Gilbert DA, Tedesco FJ, et al: the National ASGE survey on upper gastrointestinal bleeding. Gastrointestinal Endoscopy 1981; 27 (2): 73-103
    Search Terms: ?
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer: Horand Meier

    Clinical Question.
    Patient upper GI bleed
    Intervention or Exposure
    Outcome death, surgery, complications