ArticleSurgical endoscopy2026
Predictors and therapeutic yield of oesophagogastroduodenoscopy in critically and morbidly ill patients presenting with coffee-ground vomitus.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCoffee-ground vomitus in critically ill patients causes anxiety among healthcare providers. It commonly prompts endoscopic examination for both diagnostic and therapeutic purposes. Performing upper gastrointestinal endoscopy in this cohort is not without potential complications. The study objective was to assess the outcomes of endoscopy and to identify clinical factors associated with therapeutic endoscopic intervention.
methodsA retrospective cross-sectional study was conducted using data of 245 critically and morbidly ill patients presenting with coffee-ground vomitus who underwent endoscopy between 2015 and 2025 at Malacca Hospital. Variables included demographics, clinical and laboratory parameters, endoscopic timing and findings, and clinical outcomes. The Chi-square test or Fisher's exact test were used for univariate analysis, and variables with p < 0.25 were entered into a multivariable analysis to identify independent predictors of endoscopic intervention.
resultsA total of 245 patients were included; 81 (33.1%) underwent therapeutic endoscopic intervention, while 164 (66.9%) underwent diagnostic endoscopy alone. Endoscopic findings were inflammatory in 67 (27.3%), low-risk ulcers in 60 (24.5%), high-risk ulcers in 59 (24.1%), tumors in 8 (3.3%), varices in 3 (1.2%), and 15 (6.1%) patients had normal findings. Age < 60 years, hemoglobin < 10 g/dL, and urea > 6.5 mmol/L were significantly associated with therapeutic intervention. Multivariable analysis identified hemoglobin < 10 g/dL (p = 0.033) and urea > 6.5 mmol/L (p = 0.010) as independent predictors of endoscopic intervention.
conclusionIn critically and morbidly ill patients presenting with coffee-ground vomitus only one-third received therapeutic endoscopic procedure. Hemoglobin < 10 g/dL and blood urea > 6.5 mmol/L were independently associated with therapeutic endoscopic intervention. These findings support further evaluation of a selective, risk-based approach to prioritizing endoscopy; prospective validation is required before such an approach can be recommended for clinical practice.
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