Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Lingyu Bao, MD Co-Author: Alex Vargas Romero, MD – Dr., Montefiore Medical Center, Wakefield
Introduction: Upper gastrointestinal bleeding (UGIB) is a critical condition often requiring intensive care unit (ICU) admission and blood transfusion. While esophagogastroduodenoscopy (EGD) is widely recommended for UGIB management, evidence supporting its benefit in ICU settings is limited. This study evaluates the outcomes of EGD compared to conservative management in ICU patients with UGIB requiring transfusion.
Methods: We analyzed de-identified patient data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients diagnosed with acute UGIB using International Classification of Diseases (ICD) codes and requiring transfusion during ICU stay were included. Patients were categorized into two groups: EGD and conservative treatment. Primary outcomes included in-hospital mortality, ICU length of stay, and total hospital length of stay. Subgroup analyses were conducted based on vasopressor use and type of bleeding (variceal vs. non-variceal).
Results: A total of 874 patients were analyzed (EGD: 465; conservative: 409). Mortality rates were similar between the EGD and conservative groups (6.9% vs. 8.1%, p=0.505). However, patients undergoing EGD required significantly more red blood cell transfusions (1.1 vs. 0.7 liters, p< 0.001) and had prolonged ICU stays (2.6 vs. 1.9 days, p< 0.001) and hospitalizations (6.7 vs. 5.6 days, p=0.013). Subgroup analysis revealed no significant differences in outcomes for patients requiring vasopressors or with variceal bleeding. However, in patients without vasopressors or with non-variceal bleeding, EGD significantly prolonged ICU stays (p < 0.001). Kaplan-Meier survival analysis showed no difference in one-year mortality between the two groups.
Conclusions: In ICU patients with UGIB requiring transfusion, conservative management may be preferred over EGD due to comparable mortality outcomes but fewer complications, including shorter ICU and hospital stays. Conservative strategies should be prioritized, particularly in patients without vasopressors or with non-variceal bleeding, to minimize resource utilization and potential procedural risks.
