Very early versus early endoscopy in acute non-variceal upper gastrointestinal bleeding: A prospective cohort study with propensity score matching.

OBJECTIVE: To evaluate whether endoscopy within 12 h improves clinical outcomes compared with endoscopy performed between 12 and 24 h in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB). PATIENTS AND METHODS: This prospective cohort study included adults with acute NVUGIB who underwent upper GI endoscopy within 24 h of emergency department presentation. Patients were grouped according to endoscopy timing: within 12 h and between 12 and 24 h. Clinical outcomes were compared before and after propensity score matching. The primary outcome was a 30-day composite adverse outcome, defined as death or rebleeding. RESULTS: A total of 285 patients were included, of whom 108 underwent endoscopy within 12 h and 177 between 12 and 24 h. After PSM, 103 patients remained in each group. The 30-day composite adverse outcome was similar between the within-12-h and 12-24-h groups (6.8% vs. 7.8%, p=1.000). No significant differences were observed in 30-day mortality (4.9% vs. 2.9%, p=0.727), rebleeding (1.9% vs. 5.8%, p=0.289), ICU admission (29.1% vs. 35.9%, p=0.371), inotropic support (3.9% vs. 6.8%, p=0.549), or prolonged hospitalization (24.3% vs. 31.1%, p=0.324). In multivariable logistic regression, endoscopy within 12 h was not independently associated with the 30-day composite adverse outcome (adjusted OR 0.768, 95% CI 0.313-1.881; p=0.564). CONCLUSION: In acute NVUGIB managed within the 24-h window, routine endoscopy within 12 h was not associated with a statistically significant improvement in clinical outcomes compared with endoscopy performed between 12 and 24 h, supporting risk-adapted timing after stabilization.