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Endoscopy Is Relatively Safe in Patients with Acute Ischemic Stroke and Gastrointestinal Hemorrhage

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Abstract

Background

Gastrointestinal hemorrhage (GIH) is reported to occur in 1–8% of patients admitted with acute ischemic stroke (AIS). AIS is considered to be a relative contraindication to GIE.

Aims

Evaluate the outcomes of gastrointestinal endoscopy (GIE) in patients hospitalized with AIS and GIH.

Methods

Patients hospitalized with AIS and GIH were included from the National Inpatient Sample 2005–2014. Primary outcome measure was in-hospital mortality in patients with AIS and GIH who underwent gastrointestinal endoscopy. Secondary outcomes were (1) resource utilization as measured by length of stay (LOS) and total hospitalization costs and (2) to identify independent predictors of undergoing GIE in patients with AIS and GIH. Confounders were adjusted for by using multivariable regression analysis.

Results

A total of 75,756 hospitalizations were included in the analysis. Using a multivariate analysis, the in-hospital mortality was significantly lower in patients who underwent GIE as compared to those who did not [aOR: 0.4, P < 0.001]. Patients who underwent GIE also had significantly shorter adjusted mean LOS [adjusted mean difference in LOS: 0.587 days, P < 0.001]. Patients with AIS and GIH who did not undergo GIE had significantly higher adjusted total hospitalization costs. [Mean adjusted difference in total hospitalization costs was $5801 (P < 0.001).] Independent predictors of undergoing GIE in this population were male gender, age > 65 years, Asian or Pacific race, hypovolemic shock, need for blood transfusion and admission to urban non-teaching hospital.

Conclusions

Gastrointestinal endoscopy can be safely performed in a substantial number of patients with AIS and GIH.

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Authors and Affiliations

  1. Department of Internal Medicine, New York Medical College, Valhalla, NY, 10595, USA

    Mohamed Tausif Siddiqui & Christopher Nabors

  2. Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, 77555, USA

    Mohammad Bilal

  3. Department of Gastroenterology, New York Medical College, Valhalla, NY, 10595, USA

    Lakshmi Asritha Gollapudi, Dhruv Mehta, Jonathan Barsa, Beth Schorr-Lesnick, Edward Lebovics & Virendra Tewari

  4. Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, 15212, USA

    Shifa Umar

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  1. Mohamed Tausif Siddiqui
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  3. Lakshmi Asritha Gollapudi
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Correspondence to Mohamed Tausif Siddiqui.

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Appendix: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Appendix: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Diagnosis/procedure name

ICD-9-CM code

Cerebrovascular accident

 Acute ischemic stroke (AIS)

433.00, 433.01, 433.10, 433.11, 433.20, 433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90, 434.91, 437.1

 Acute hemorrhagic stroke

430, 431, 432.0, 432.1, 432.9

Upper gastrointestinal bleeding

 Bleeding esophageal varices

456.0,456.2

 Bleeding peptic ulcer (gastric or duodenal)

531.00, 531.01, 531.20, 531.21, 531.40, 531.41, 531.60, 531.61

532.00, 532.01, 532.20, 532.21, 532.40, 532.41, 532.60, 532.61,

533.00, 533.01, 533.20, 533.21, 533.40, 533.41, 533.60, 533.61,

534.00, 534.01, 534.20, 534.21, 534.40, 534.41, 534.60, 534.61

 Mallory–Weiss

530.7

 Gastritis with hemorrhage

535.01, 535.11, 535.21, 535.41, 535.51, 535.61

 Alcoholic gastritis with hemorrhage

535.31

 Dieulafoy’s lesion of stomach or duodenum

537.84

 Angiodysplasia of stomach or duodenum with hemorrhage

537.83

Lower gastrointestinal bleeding:

 Hemorrhage of rectum and anus

569.3

 Diverticulosis of colon with hemorrhage

562.12

 Diverticulitis of colon with hemorrhage

562.13

 Angiodysplasia of intestine with hemorrhage

569.85

 Dieulafoy’s lesion (hemorrhage) of intestine

569.86

 Blood in stool (hematochezia/melena)

578.1

 Hemorrhage of gastrointestinal tract unspecified

578.9

 Hemorrhoids

455.2, 455.5, 455.8

 Colorectal polyps

211.3, 211.4

 Colorectal cancer

152.0, 152.1, 152.3, 152.8, 1529, 153.0,153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7,153.8, 153.9,154.0, 154.1, 154.2, 154.3, 154.8

230.0, 230.1, 230.2, 230.3, 230.4, 230.5, 230.6,230.7

 Intestinal ischemia

5570, 5571, 5579

 Non-infectious colitis

5581, 5582, 5583, 55,841, 55,842, 5589

 Inflammatory bowel disease

5550, 5551, 5552, 5559, 5560, 5561, 5562, 5563, 5564, 5565, 5566, 5568, 5569

 Colon ulcer

569.82

 Solitary rectal ulcer syndrome

569.41

 Anal fissure

565.0

 Infectious colitis

009.0–009.3

 Radiation enteritis

5581, 5582, 5583, 55,841, 55,842, 5589

Acute respiratory failure

518.81

Acute renal failure including dialysis

584.5, 584.6, 584.7, 584.8, 584.9,

(renal dialysis status)

V45.1, V56.0, V56.1

Hypovolemic shock

276.50, 276.52, 785.59

Procedures

 Blood transfusion

99.03, 99.04

 Mechanical ventilation

96.71, 96.72

 Endotracheal intubation

96.01, 96.02, 96.04, 96.05, 31.1, 31.21, 31.29

 Colonoscopy codes

4522, 4523, 4524, 4525, 4542, 4543

 Esophagogastroduodenoscopy (EGD)

45.13, 45.14, 45.16, 42.23, 44.13, 42.33, 44.43

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Siddiqui, M.T., Bilal, M., Gollapudi, L.A. et al. Endoscopy Is Relatively Safe in Patients with Acute Ischemic Stroke and Gastrointestinal Hemorrhage. Dig Dis Sci 64, 1588–1598 (2019). https://doi.org/10.1007/s10620-018-5399-3

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  • DOI: https://doi.org/10.1007/s10620-018-5399-3

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