Study On The Etiology Of Dangerous Acute Upper Gastrointestinal Bleeding And The Timing Of Endoscopic Diagnosis And Treatment

Background Dangerous acute upper gastrointestinal bleeding is a common critical disease in the department of digestive medicine.The disease develops rapidly and the mortality rate is high,which seriously endangers people’s life and health.Objective Explore the cause of dangerous acute upper gastrointestinal bleeding and the opportunity of endoscopic intervention.Methods The clinical data of patients with dangerous acute upper gastrointestinal bleeding admitted by the Department of Gastroenterology of the First Clinical Medical College of Three Gorges University from December 2018 to January 2023 were retrospectively analyzed.The patients were divided into young group(18-44 years old),middle age group(45-59 years old)and old age group(≥ 60 years old)according to their age,and the differences in the etiology of the three groups were compared.They were divided into three groups according to the time of endoscopic intervention: emergency endoscopic group(endoscopic intervention within 12 hours of admission),early endoscopic group(endoscopic examination within 12 hours of admission),and selective endoscopic group(endoscopic examination after 24 hours of admission).Compare the mortality rate,etiology detection rate,rebleeding,re-endoscopy,interventional or surgical operation,blood transfusion volume,hospital stay(days in general ward and days in ICU),hospital expenses and other indicators of the three groupsResults Peptic ulcer is the most common cause of dangerous acute upper gastrointestinal bleeding.Other common causes are malignant tumors of the upper gastrointestinal tract,cardiac mucosal tear syndrome,vascular malformation,etc.There are statistical differences in the composition of causes among different age groups(P<0.05).The mortality of emergency endoscopy group and early endoscopy group was lower than that of selective endoscopy group,and the mortality of emergency endoscopy group was the lowest(P<0.05).Compared with the other two groups,the emergency endoscopy group had less red blood cell infusion,shorter hospital stay and lower hospital expenses(P<0.05).Compared with the emergency endoscopy group,the early endoscopy group and the selective endoscopy group had a higher detection rate of etiology.However,there was no significant difference among the three groups in terms of the rate of rebleeding,the rate of endoscopic therapy,and the rate of intervention or surgery(P>0.05).Conclusion Emergency endoscopic intervention can reduce the mortality of patients,reduce the amount of red blood cell infusion,shorten the length of hospitalization,reduce the cost of hospitalization,avoid the waste of medical resources,and reduce the economic burden of patients.However,emergency endoscopic intervention has no significant impact on patients’ rebleeding rate,re-endoscopic treatment rate,interventional or surgical operation rate,and the number of patients transferred to ICU,and cannot improve the detection rate of etiology.