“First look” unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation - 23/04/14

Doi : 10.1016/j.clinre.2013.10.010

Jérôme Rivory ^a,^b, Vincent Lépilliez ^a, Rodica Gincul ^a, Olivier Guillaud ^a, Mélanie Vallin ^a,^b, Yves Bouffard ^c, Pierre Sagnard ^c, Thierry Ponchon ^a,^b, Jérôme Dumortier ^a,^b,^⁎
^a Hospices civils de Lyon, hôpital Edouard-Herriot, fédération des spécialités digestives, Lyon, France
^b Université Claude-Bernard Lyon-1, Villeurbanne, France
^c Hospices civils de Lyon, hôpital Edouard-Herriot, département d’anesthésie-réanimation, Lyon, France

^⁎Corresponding author. Pavillon H, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France. Tel.: +33 4 72 11 01 11; fax: +33 4 72 11 01 47.

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

pages	10
Iconographies	1
Vidéos	0
Autres	0

Summary

Background and aims

With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB).

Patients and methods

One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as “first look”. Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed.

Results

Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant.

Conclusions

Our results strongly support that “first look” unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.

Le texte complet de cet article est disponible en PDF.