Page 65 - Magyar Gasztroenterológiai Társaság 2020. november 6–7. – ONLINE KONGRESSZUS

Előadáskivonatok / Abstracts

with significant morbidity and mortality. The assessment of included demographic characteristics, vital signs at
severity is crucial in the management of the disease. Current admission, comorbidities, medications, time to hospital
methods of risk stratification in AP have a limited value. Early admission and endoscopy, laboratory results, endoscopic
recognition of severe disease may prevent serious adverse management, including endoscopic therapy and second look
events and improve patient management, as well as overall endoscopy, risk assessment using Glasgow-Blatchford
clinical outcome. The EASY trial is an observational, Score (GBS), Rockall Score (RS) and the American Society
multicenter, prospective cohort study for establishing a of Anesthesiologists (ASA) Physical Status Score,
simple, easy and accurate clinical scoring system for early transfusion requirements, length of hospital stay and
prognostication of AP. mortality.
Methods: Evaluation of simple attainable potential Results: 108 cases (male: 69.4%) of acute variceal GI
prognostic parameters obtained at admission (or not later bleeding were registered during the 1-year study period,
than 6-12 hours afterwards) from patients diagnosed with AP providing an estimated incidence rate of 8.54 (CI95% 7.08-
will be performed to assess their potential correlation with the 10.32) per 100,000 population per year in Western Hungary.
disease severity. Approximately 1200 patients from multiple Time from symptom onset to presentation at Emergency
international centers will be enrolled into this trial using the Department (ER) was <6 hours in 41.4%, and <12 hours in
Registry. 64.6% (n=99). Time from hospitalization to endoscopy was <
Results: 1183 patients were enrolled in the EASY study from 6 hours in 66.7%, and <12h in 81.5%. Endoscopy revealed
different international centers so far. The association grade 3-4 varices in 63% of patients according to the
between the investigated parameters with the severity and Paquet's classification of varices. Endoscopic therapeutic
mortality were the primary endpoints of the study. Abdominal intervention was performed in 57.4%, and 38.0% of patients
guarding had significantly higher rate in severe AP group vs required second look endoscopy. On initial endoscopy,
in mild and moderate (43 % vs 20 %, 28 %). Analysis of 39.8% of patients were treated with sclerotherapy, 18.5%
kidney function showed that serum creatinine level were had ligation and 5.6% balloon tamponade. 76.9% of the
significantly higher in severe and moderate AP groups vs in patients required blood transfusion. Hospitalization length
mild one (120±14; 94±4 vs 82±1 µmol/l). Serum amylase exceeded 7 days in 45.4% of the patients. Mortality was
level was significantly elevated in severe group compared to 18.2% among patients with bleeding episode presenting
mild and moderate AP groups (1372±78; 1100±40; 1060±46 outside the hospital, while the overall mortality rate (including
U/min). Serum glucose levels were significantly elevated in in-hospital bleedings) reached 24.1%. There was no
severe and moderate groups compared to mild AP group significant difference in mortality or transfusion requirements
(8±1.5; 7.6±0.7; 4.2±1.1 mmol/l). Pleural effusion occured based on prehospital time or weekend management (p=NS).
more frequent in moderate (18 %) and severe groups (20 %) Presentation of vegetative symptoms at admission (i.e.
vs in mild one (7%). tachycardia, hypotension or syncope) was associated with
Conclusion: EASY score may be a fast and accurate system increased rates of transfusion (p=0.003). The Paquet’s grade
to evaluate the early severity of AP after hospital admission. of varices was correlated with the transfusion needs
Although some parameters (abdominal guarding, pleural (p=0.036), endoscopic therapy (p<0.001), and showed
effusion, elevated serum creatinine, amylase, glucose levels, similar trend for mortality (p=NS). The increased international
higher BMI) have shown correlation with the severity of AP in normalized ratio (INR) and creatinin levels were associated
early phase of the disease, we have to include more patients with mortality (p=0.001 and p=0.002). The GBS best
to have reliable results. predicted transfusion requirements (AUC: 0.793; cut-off:
GBS >8 points; sensitivity: 72.3% specificity: 76%). The
82. INCIDENCE, PREDICTIVE FACTORS AND frequency of known ETOH dependency and systemic
OUTCOMES OF VARICEAL UPPER comorbidity was 84.3% and 98.1% in this population. The
GASTROINTESTINAL BLEEDING – A PROSPECTIVE patients’ ASA stage was associated with transfusion
MULTICENTER POPULATION-BASED STUDY FROM requirements (ASA 1-2 vs. ASA 3-4: OR 7.6, CI95% 2.7-21.6;
HUNGARY p<0.001), endoscopic intervention (OR 12.6, CI95% 3.4-
4
3
1
2
5
Lakatos L. , Gonczi L. , Izbeki F. , Patai A. , Racz I. , 46.5; p=0.033), and showed similar trend with mortality (OR
Gasztonyi B. , Varga-Szabo L. , Rozsa F. , Lovasz B. , Ilias 3.6, CI95% 0.8-16.7; p<0.095).
6
2
2
7
2
2,8
A. , Lakatos P. Conclusion: Incidence rates of acute variceal GI bleeding in
1. 1st Dept. of Internal Medicine, Csolnoky F. County Western Hungary are high. The ASA-score, GBS predicted
Teaching Hospital, Veszprem; 2. 1st Dept. of Medicine, outcomes and transfusion requirements. Although
Semmelweis University, Budapest; 3. 1st Dept. of Internal comorbidities are very high in this population, the observed
Medicine, St. Georg Teaching Hospital, Szekesfehervar; 4. high mortality rates, coupled with relatively low rates of
2nd Dept. of Internal Medicine, Markusovszky F Teaching endoscopic ligation warrant optimization of management
Hospital, Szombathely; 5. 1st Dept. of Internal Medicine, strategies in acute variceal GI bleeding.
Petz A Teaching Hospital, Gyor; 6. 2nd Dept. of Internal
Medicine, St. Rafael Teaching Hospital, Zalaegerszeg; 7. 83. INCIDENCE, PREDICTIVE FACTORS AND
Dept. of Gastroenterology, St. Pantaleon Hospital, OUTCOMES OF NON-VARICEAL UPPER
Dunaujvaros; 8. McGill University Health Center, Montreal GASTROINTESTINAL BLEEDING – A PROSPECTIVE
General Hospital, Canada MULTICENTER POPULATION-BASED STUDY FROM
HUNGARY
3
2
1
Introduction: Acute variceal gastrointestinal (GI) bleeding is Lakatos L. , Gonczi L. , Izbeki F. , Patai A. , Racz I. ,
5
4
6
2
2
7
associated with significant morbidity and mortality. Gasztonyi B. , Varga-Szabo L. , Rozsa F. , Lovasz B. , Ilias
Aims: Our aim was to evaluate characteristics and A. , Lakatos P.
2,8
2
prognostic factors in the management of acute upper GI 1. 1st Dept. of Internal Medicine, Csolnoky F. County
bleeding in a large multi-center study from Hungary. Teaching Hospital, Veszprem; 2. 1st Dept. of Medicine,
Methods: The present prospective one–year study involving Semmelweis University, Budapest; 3. 1st Dept. of Internal
six major community hospitals in Western Hungary covering Medicine, St. Georg Teaching Hospital, Szekesfehervar; 4.
a population of 1,263,365 persons in 2016. Data collection 2nd Dept. of Internal Medicine, Markusovszky F. Teaching
63

Central European Journal of Gastroenterology and Hepatology 63
Volume 6, Supplementum 2 / November 2020