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Novel Nasogastric Tube-Related Criteria for Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Bleeding

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Abstract

Background

Patients with active upper gastrointestinal bleeding (UGIB) require urgent endoscopy, but appropriate criteria for urgent endoscopy in these patients have not yet been established.

Aims

The goal of this study is to establish a simple system for the selection of UGIB patients who may benefit from urgent endoscopy.

Methods

Of the 335 patients who required emergency hospitalization for UGIB from May 2010 to March 2012 at Nagoya Daini Red Cross Hospital, 166 patients who underwent placement of a nasogastric tube (NGT) were retrospectively identified. Active bleeding on the endoscopic image was used as an endpoint that reflected the need for urgent endoscopy.

Results

The ratio of the heart rate to the systolic blood pressure (HR/SBP ratio) and aspiration of fresh or dark red fluid from the NGT [NGT(+)] were significant predictors of active bleeding in the univariate analysis [HR/SBP ratio, P = 0.016; NGT(+), P < 0.001]. The HR/SBP ratio [odds ratio (OR) 8.118; 95 % confidence intervals (CI) 1.696–38.850; P = 0.009] and NGT(+) (OR 4.630; 95 % CI 2.092–10.204; P < 0.001) were also significantly associated with active bleeding in the multivariate analysis. Moreover, receiver operating characteristic analysis revealed a setting with HR/SBP ratio >1.4 or NGT(+) to be optimal criteria to predict active bleeding. These criteria were associated with a sensitivity of 64.9 % (24/37) and a specificity of 76.7 % (99/129) for the prediction of active bleeding; consequently, they are superior to the sensitivity and specificity of previously proposed criteria.

Conclusions

A novel and simple criteria system using NGT(+) and HR/SBP is a good predictor of the need for urgent endoscopy in patients with nonvariceal UGIB.

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Authors and Affiliations

  1. Department of Gastroenterology, Nagoya Daini Red Cross Hospital, 2-9 Myouken-cho, Showa-ku, Nagoya, 466-8650, Japan

    Hiroyasu Iwasaki, Tomonori Yamada, Miho Aoki, Satoshi Nomura, Atsunori Kusakabe, Hiroshi Kanie, Tesshin Ban, Katsumi Hayashi & Etsuro Orito

  2. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

    Takaya Shimura & Takashi Joh

  3. Vascular Biology Program and Department of Surgery, Boston Children’s Hospital, 300 Longwood Ave., Karp12.007C, Boston, MA, 02115, USA

    Takaya Shimura

  4. Department of Surgery, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA

    Takaya Shimura

Authors
  1. Hiroyasu Iwasaki
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  2. Takaya Shimura
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  3. Tomonori Yamada
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  4. Miho Aoki
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  5. Satoshi Nomura
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  6. Atsunori Kusakabe
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  7. Hiroshi Kanie
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  8. Tesshin Ban
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  9. Katsumi Hayashi
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  10. Takashi Joh
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  11. Etsuro Orito
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Correspondence to Takaya Shimura.

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Iwasaki, H., Shimura, T., Yamada, T. et al. Novel Nasogastric Tube-Related Criteria for Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Bleeding. Dig Dis Sci 58, 2564–2571 (2013). https://doi.org/10.1007/s10620-013-2706-x

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  • DOI: https://doi.org/10.1007/s10620-013-2706-x

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