D0309 - The Timing of Esophagogastroduodenoscopy (EGD) and Its Impact on Patients With Cirrhosis and Upper GI Bleeding

Michael Ramada, MD¹, Zankesh Patel, MD¹, Rasheda Browne, MD¹, Tai-Ping Lee, MD², Chun Kit Hung, MD^2
1Zucker SOM at NSUH-LIJ - Northwell Health, Manhasset, NY; ²Zucker SOM at Hofstra University - Northwell Health, Manhasset, NY

Introduction: GI bleeding in patients with cirrhosis, particularly those with gastroesophageal variceal bleeding have a high rate of morbidity and mortality. Gastroenterological society guidance has recommended endoscopy within 24 hours for GI bleeding. However, endoscopy for GI bleeding in patients with alcohol associated cirrhosis is frequently delayed due to withdrawal concerns. We studied the timing of endoscopy for GI bleeding in patients with alcohol use disorder (AUD) associated cirrhosis and its impact on outcomes.

Methods: A retrospective chart review of patients age 18- 90 with a diagnosis of cirrhosis and GI bleeding, identified by ICD codes at Northwell Health’s tertiary medical centers from 10/2019 to 2/2022 was conducted. Data regarding time from admission to EGD, age, gender, history of alcohol use, MELD-Na score, length of hospital stay, benzodiazepine requirements, admission to the ICU, and mortality were assessed and analyzed. Timing of endoscopy was categorized as early or late (< 24 and >24 hours within admission respectively).

Results: A total of 205 patients were found to have AUD and alcohol associated cirrhosis. Of these, 150 eventually underwent EGD during the admission. Early EGD did not correlate with MELD-Na scores, mortality, blood transfusion requirements, admission hemoglobin, or length of stay (Table 1).  However, those who underwent EGD within the first 24 hours had higher rates of ICU admission (RR 2.4217 and CI 1.5037-3.9001, p=0.0003). The need for benzodiazepine use for alcohol withdrawal  had a slight positive association with late endoscopy (RR = 1.4239, CI 1.0633-1.9068, p=0.0177) but did not affect mortality (RR 1.1086, CI 0.7153-1.7182, p=0.6447) or ICU admissions (RR 1.1086, CI 0.7153-1.7182, p=0.6447).

Discussion: In patients with alcohol withdrawal and active GI bleeding, early compared to late EGD past 24 hours appears to not have an impact on patient’s mortality and length of stay in the hospital. Early EGD is associated with significantly higher rates of ICU admission, as it facilitates the setting for earlier EGD and is not an adverse event. Our study suggests that a late EGD pending control of alcohol withdrawal symptoms is not associated with adverse outcomes. A further larger series study is warranted to delineate the optimal timing of endoscopy in this particular population.



Disclosures:


Michael Ramada, MD¹, Zankesh Patel, MD¹, Rasheda Browne, MD¹, Tai-Ping Lee, MD², Chun Kit Hung, MD². D0309 - The Timing of Esophagogastroduodenoscopy (EGD) and Its Impact on Patients With Cirrhosis and Upper GI Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.