Acute Upper GI Bleeding: Good Night, Sleep Tight, Endoscopy Can Wait until Morning Light.

Abstract

Gastrointestinal hemorrhage is the leading cause of hospitalization in gastroenterology (Gastroenterology 2019;156:254–272). Prognostic scoring systems for acute upper GI bleeding (AUGIB), such as the Glasgow-Blatchford score (GBS) or Rockall score, can help to predict which patients require intervention (Lancet 2000;356:1318–1321; Gut 1996;38:316–321). Evidence does not strongly favor 1 particular index, but the GBS has good sensitivity for detecting patients at high risk of rebleeding and death. Nevertheless, mortality in AUGIB remains essentially unchanged over the past 2 decades. Despite advances in endoscopic and pharmacological therapies, case fatality is approximately 5%–10% globally (BMJ 1995;311:222–226). Historically, a major focus to improve outcome has centered on performing timely endoscopy to achieve early hemostatic control.