S1409 Timing of Endoscopy and Associated Factors in Patients Presenting With Upper Gastrointestinal Bleeding in Lagos, Nigeria

Introduction: Upper gastrointestinal bleeding (UGIB), which includes bleeding from the oesophagus, stomach and duodenum, is a common and challenging gastrointestinal emergency with significant mortality. Although guidelines recommend endoscopy within 24 hours of presentation, after resuscitation, endoscopy is frequently delayed. This situation is worsened locally by out-of-pocket payment for services. There is a dearth of studies evaluating the association of endoscopy timing on patient outcomes in Nigeria. Our aim was to describe the clinical characteristics and outcomes of patients hospitalised for UGIB in our centre, examining more closely their association with timing of endoscopy. Methods: Prospective, single center study of adult patients with UGIB in Lagos, Nigeria, between January 2022 and December 2024. Study received ethical approval. Time to endoscopy was categorised as early (≤24 hours) or delayed (>24 hours). Clinical, demographic and outcome data were compared between early and delayed endoscopy procedures with Student’s t-test, Mann-Whitney U test, Pearson’s chi-square test or Fisher’s exact using R software. Analyses were 2-tailed, and statistical significance set at P < 0.05. Results: The data of 102 patients were analysed, mean age 53.6 years, men 69 (67.6%), comorbidity in 78 (76.5%), and previous UGIB in 15 (14.7%). Thirteen (12.7%) presented with haematemesis only, 41 (40.2%) melaena only, and 48 (47%) with both. Eighty-5 (83.3%) received blood transfusion. Mean pre-endoscopy Rockall score was 2.7, mean length of hospital stay was 9.9 days and in hospital mortality rate was 30.4%. Sixty-8 (66.7%) underwent endoscopy, early in 16 (23.5%) and delayed in 52 (76.5%). Reasons for delay included weekend presentation (30, 57.7%), haemodynamic instability (16, 30.8%), financial constraints (11, 21.2%) and patient’s refusal (1, 1.9%). Sex, mean age, presence of comorbidity, systolic blood pressure, number of units of blood transfused and Rockall scores did not differ by timing of endoscopy. The early group had shorter hospital stay and greater in hospital mortality. Conclusion: A third of patients with UGIB did not undergo endoscopy, and this was delayed in 3 quarters. Early endoscopy was associated with shorter length of hospital stay but increased in hospital mortality. Strategies are needed to improve the availability and access to endoscopy in patients with UGIB.