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?:abstract
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BACKGROUND AND AIMS: Acute oesophageal variceal haemorrhage (AOVH) is a medical emergency. The American Association for the Study of Liver Diseases (AASLD) recommended endoscopy management as soon as possible and not more than 12 hours after presentation. The United King guidelines recommended endoscopy for unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and within 24 hours of admission. The aim of the study is to evaluate the outcome of endoscopic management of AOVH in less than 12 hours compared to 12-24 hours post admission. METHODS: We recruited 297 patients with AOVH. The patients were divided into groups depending on the timing of the endoscopic management: 180 within 12 h of admission and 117 patients at 12-24 hours of admission. Routine clinical and laboratory data were collected. RESULTS: Compared to patients with endoscopic management at 12-24 hours (mean 16 hours), patients with endoscopic management within 12 hours (mean 8.3 hours) of admission had fewer hospital stay days (P= 0.001), significant reduction of ammonia levels (P< 0.0001) and significant improvement in associated hepatic encephalopathy grade (p=0.048). There were no major clinical vents in the <12 hour group, but 8 events in the 12-24 hour group (p<0.01). CONCLUSION: Endoscopic management of acute esophageal variceal bleeding within 12 hours of admission is superior to endoscopic management at 12-24 hours of admission regarding, reduction of hospital stay, ammonia levels, correction of hepatic encephalopathy, re-bleeding and mortality rate, hence, reduce the cost of treatment, benefiting patient satisfaction and hospital bed availability.
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