Tempo de execução de endoscopia e sua relação com as características clínicas e endoscópicas de pacientes com hemorragia digestiva alta não varicosa por úlcera péptica em um hospital terciário do Nordeste do Brasil

Abstract

Introduction: Non-variceal upper gastrointestinal bleeding (NVHD) is a common cause of hospital admission in the world with considerable morbidity and mortality. The time for clinical stabilization, performance of upper digestive endoscopy (UGE) and length of hospital stay are impacting factors in the outcome of this patient. In this study, we evaluated the relation between the execution time of EDA and several clinical, laboratory and endoscopic parameters in patients with NVHD due to peptic ulcer disease (PUD) admitted to a tertiary hospital in the state of Ceará for 1 year. Methodology: This retrospective and cross-sectional cohort study was approved by the Ethics Committee. Data collection was carried out through the medical records of patients admitted to the referenced emergency service of the Hospital Regional Norte – Sobral – CE, with the diagnosis of HDANV in the period from August 1, 2018 to July 31, 2019. 67 patients admitted with a diagnosis of upper digestive hemorrhage were selected with HDANV, being divided into two groups: less than 12 hours of EDA performance (G1) and more than 12 hours of EDA performance (G2) using analyzes by the test Mann-Whitney and chi-square tests. Results: of the 67 admitted patients, 51 (76%) were men; 50.7% were under 60 years of age; analysis of the association between patients' age and the time of performance of UDE, indicated significance between groups G1 and G2 (p<0.043). Significance (p<0.001) was observed between the time of performing the EDA and the need for transfusion and analysis of the association between the time of performing the UDE and Hematocrit (p<0.001) and Hemoglobin (p<0.001). The main cause of bleeding was gastric ulcer (55.2%) and antral ulcer (49%). Regarding the use of pre-admission medication, 32.8% reported the use of AAS and NSAIDs; 46.2% of patients underwent endoscopic treatment. Between groups, there was an association between frequency (p<0.025) and length of stay. The percentage of death was 7.4%. Endoscopic characteristics indicate a higher prevalence in G1 for Forrest II classification and in G2 for Forrest III even without significance (p<0.134). In addition, the Rockall scale did not have an association between the time of performing EDA (p<0.443). Conclusion: The analysis of the association between groups G1 and G2 showed an expected frequency among patients, indicating a greater need for transfusion, lower hematimetric indices and longer hospital stay for G2. The Rockall score was not associated with groups. Patients in group G2 had a longer time to stabilize, requiring more medical and hospital care, longer hospital stays, and a greater tendency to mortality.