Impact of timing of endoscopy on clinical outcomes in cirrhotic patients with esophageal variceal bleeding: a monocentric retrospective study from Vietnam.

INTRODUCTION

In cirrhotic patients with esophageal variceal bleeding (EVB), most guidelines recommend endoscopy within 12 h. However, the optimal timing for the highest treatment efficacy remains controversial, and current studies provide inconsistent results. This study aims to evaluate the optimal timing by comparing clinical outcomes between early endoscopy (< 12 h) and delayed endoscopy (≥12 h) groups.

METHODS

A retrospective study was conducted on 265 cirrhotic patients with EVB who underwent endoscopic variceal ligation (EVL) from January 2022 to December 2024. Patients were divided into early and delayed endoscopy groups based on the timing of endoscopic intervention since admission. The primary outcome was the 5-day treatment failure.

RESULTS

Among the 265 eligible patients, 109 (41.1%) underwent early endoscopy, while 156 (58.9%) underwent delayed endoscopy. There were no statistically significant differences between the early and delayed endoscopy groups regarding 5-day treatment failure (10.1% vs. 9%, p = 0.759), in-hospital mortality (10.1% vs. 7.1%, p = 0.377), the need for ICU care (13.8% vs. 10.9%, p = 0.481), total blood transfusion units (p = 0.585), hemoglobin decrease requiring transfusion (p = 0.31), and the length of hospital stay (p = 0.35). Similarly, after Propensity Score Matching, no significant differences were observed between the two groups regarding those outcomes. Univariate and multivariate logistic regression analysis identified low systolic blood pressure (OR = 0.959, CI: 0.927-0.992), elevated serum creatinine levels (OR = 1.026, CI: 1.004-1.047), and Child-Pugh class C (OR = 7.516, CI: 1.538-36.721) at admission were independently associated with an increased risk of in-hospital mortality.

CONCLUSION

The timing of endoscopy (before or after 12 h) does not significantly affect clinical outcomes in EVB patients. Endoscopy timing should depend on the patient's condition and clinical judgement. Key predictors of in-hospital mortality include low systolic blood pressure, high serum creatinine levels, and Child-Pugh class C at admission.