PeerJ
Is ultra-early endoscopy always beneficial? A systematic review and meta-analysis of timing-dependent outcomes in nonvariceal upper gastrointestinal bleeding
By Liu CJ, Xiong LX, Zhang XY and 4 others.
Abstract
Background
Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common emergency with substantial morbidity and mortality. Guidelines recommend endoscopy within 24 hours, but the benefit of ultra-early endoscopy (≤6 hours) remains unclear, particularly in high-risk patients. This study aimed to systematically evaluate whether ultra-early endoscopy (≤6 hours) improves clinical outcomes compared with early endoscopy (>6 hours) in adult patients with nonvariceal upper gastrointestinal bleeding, including mortality, rebleeding, healthcare utilization, and outcomes in high-risk subgroups.
Methods
A systematic review and meta-analysis of studies comparing ultra-early and early endoscopy in adults with NVUGIB was conducted. The PubMed, Embase, and Web of Science databases were searched up to January 2026 for relevant studies. Ultra-early endoscopy was defined as endoscopy performed within 6 hours of presentation, admission, or clinical diagnosis, and high-risk patients were defined according to study-level criteria, most commonly a Glasgow-Blatchford score >12 or Rockall Score >5. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models, and prespecified subgroup and sensitivity analyses were used to assess the robustness of the findings.
