Clinical outcomes of gastroscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding
Abstract Background: Gastroscopy is a useful procedure for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend on the choice of gastroscopy implementation in the intensive care unit (ICU) patient with suspected GI bleeding. The objective of this retrospective study was to compare the clinical effectiveness of gastroscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding.Methods: ICU patients using a high-does proton pump inhibitor for suspected GI bleeding from January 2015 to February 2020 were retrospectively included. Massive GI bleeding, such as hematemesis and hematochezia, were excluded. After propensity score matching (PSM) between the gastroscopy and no gastroscopy groups, the change in hemoglobin level, requirement of RBC transfusion, length of ICU stay, and ICU mortality were compared. Results: Of the 116 subjects included, 34 patients had gastroscopy during ICU stay. Among the gastroscopy group, 13 (38.2%) patients showed normal findings, and the most frequent abnormal finding was gastric ulcer (n = 9, 26.5%), and 12 patients (35.3%) had a hemostatic procedure. After PSM, the gastroscopy group needed more red blood cell transfusion than the no-gastroscopy group (P = 0.01). There was no significant difference in the change in hemoglobin level (P = 0.10), length of ICU stay (P = 0.64), and ICU mortality (P = 0.55).Conclusion: This retrospective study showed that gastroscopy had no definite clinical benefit in ICU patients using high-dose proton pump inhibitor for suspected GI bleeding.