B0281 - The Correlation Between Early Endoscopy and In-Hospital Outcomes in Patients With Upper GI Malignancies Admitted for Upper GI Bleeding

Suhail Haddadin, MD¹, Patricia Miguez Arosemena, MD¹, Farah Haddadin, ², Rand Fram, ², Bruce Gelman, MD^1
1Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY; ²The University of Jordan, Amman, 'Amman, Jordan

Introduction: Upper gastrointestinal bleeding (UGIB) in the setting of UGI malignancies is challenging due to friable vasculature. Data on the role of esophagogastroduodenoscopy (EGD) remains limited on improving overall outcomes. New therapeutics are now available to achieve hemostasis during EGD such as Hemospray which prompts promising outcomes for early interventions. The goal of this report was to investigate whether early EGD in cancer related UGIB improves overall in-hospital outcome using a large representative database.

Methods: Using the National Inpatient Sample, we examined patient characteristics and predictors for in-hospital outcomes for patients with UGI malignancies (esophagus to stomach) admitted with UGIB stratified based on undergoing early EGD (≤ 24 hours) vs not during 2016. In-hospital outcomes of interest were all-cause mortality, need for blood transfusion, invasive mechanical ventilation, length of stay and total hospital charge. Multivariate analysis was used to predict in-hospital outcomes stratified based on undergoing early EGD after adjusting for baseline characteristics, Charlson comorbidity index, day of admission during the week and medical comorbidities.

Results: In our retrospective study, a total of 1,935 patients with UGI malignancy were admitted for UGIB in 2016, of which 695 (35.9%) underwent early EGD. Patients who underwent early EGD when compared to patients who did not had similar demographic, racial and medical comorbidities baseline characteristics. On Multivariate analysis, Early EGD patients were more likely to require blood transfusion (OR 1.77 95%-CI 1.09-2.85, P=0.020). There was a trend towards lower all-cause mortality in patients undergoing early EGD, but it did not reach statistical significance (OR 0.48 95%-CI 0.12-1.91, P=0.304). There was no significant difference in the requirement of invasive ventilation (OR 0.58 95%-CI 0.05-6.23, P=0.654), length of stay (Coef. -0.41 95%-CI -1.16-0.34) and total hospital charge (Coef. -2.38 95%-CI -1.07-5.97, P=0.576), (table).

Discussion: Early EGD did not show improved all-cause mortality rate for patients with UGI cancer who have UGIB, but showed increased requirement for blood transfusion which possibly indicates more severe bleeding and more vigilant anticipation of complications. This study preceded the approval of new therapeutics such as Hemospray, which was approved in the US in 2018, and raises the question whether outcomes would improve after further utilization of newer therapeutic innovations.



Disclosures:


Suhail Haddadin, MD¹, Patricia Miguez Arosemena, MD¹, Farah Haddadin, ², Rand Fram, ², Bruce Gelman, MD¹. B0281 - The Correlation Between Early Endoscopy and In-Hospital Outcomes in Patients With Upper GI Malignancies Admitted for Upper GI Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.