Endoscopic management and outcomes of pregnant women hospitalized for nonvariceal upper GI bleeding: a nationwide analysis

被引:6
作者
Nguyen, Geoffrey C. [1 ,2 ]
Dinani, Amreen M. [1 ]
Pivovarov, Kevin [1 ]
机构
[1] Univ Toronto, Mt Sinai Div Gastroenterol, Toronto, ON, Canada
[2] Johns Hopkins Univ, Sch Med, Dept Med, Div Gastroenterol & Hepatol, Baltimore, MD 21205 USA
关键词
MALLORY-WEISS SYNDROME; DIAGNOSIS; ACCURACY; ICD-9-CM; CODES;
D O I
10.1016/j.gie.2010.07.018
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Upper GI endoscopy has an important diagnostic and therapeutic role in the management of nonvariceal upper GI bleeding (NVUGB). Objective: To characterize nationwide patterns of utilization of upper GI endoscopy in pregnant women with NVUGB and to assess health outcomes. Design: Retrospective cohort study. Setting: Participating hospitals from the Nationwide Inpatient Sample, 1998-2007. Patients: Pregnant and age-matched nonpregnant women admitted for NVUGB. Intervention: The study population was classified as pregnant women with NVUGB (n = 1210) and nonpregnant women with NVUGB (n = 6050). Main Outcome Measurements: Rate of upper GI endoscopy, maternal mortality, fetal death/complications, and premature delivery. Results: Pregnant women were less likely than nonpregnant women to undergo upper GI endoscopy (26% vs 69%; P < .0001) even after adjustment for comorbidities, transfusion requirement, and the presence of hypo-volemic shock (adjusted odds ratio, 0.19; 95% confidence interval, 0.16-0.22). Among those who underwent endoscopy, pregnant women were less likely to undergo the procedure within 24 hours of admission (50% vs 57%; P = .02). Mortality was lower among pregnant women compared with nonpregnant women (0% vs 0.6%; P = .006). In comparing outcomes between those who did and did not undergo endoscopy, there was no difference in fetal loss (0.2% vs 0.6%), fetal distress/complications (2.7% vs 2.6%), or premature delivery (7.3% vs 6.4%). Limitations: The study was based on administrative data. Conclusion: A conservative nonendoscopic approach is common in the management of pregnant women with NVUGB and is not associated with worse maternal or fetal outcomes. Upper GI endoscopy is, however, safe when judiciously implemented in the actively bleeding patient. (Gastrointest Endosc 2010;72:954-9.)
引用
收藏
页码:954 / 959
页数:6
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