The safety of gastric ulcer biopsies and random gastric biopsies in the setting of an overt upper gastrointestinal bleed

Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Gastroenterol


Introduction: Acute upper gastrointestinal bleeding (UGIB) is a common cause of hospitalization, with an estimated incidence of 100 cases per 100,000 yearly and a mortality rate of 6-13%. EGD is the gold standard for effective diagnosis and therapy, contributing to decreased morbidity and mortality. Gastric ulcer biopsies are vital since 6% of gastric ulcers are associated with dysplasia or malignancy however many still defer gastric biopsies in the setting of UGIB. We aimed to conduct a study to assess the safety of gastric ulcer and random gastric biopsies in the setting of an UGIB. Methods: This is a retrospective study conducted at a large tertiary care center. All patients with an UGIB who had an EGD with gastric ulcer or random gastric biopsy were included. Data on demographics, baseline characteristics and outcomes were collected. Primary outcomes studied were intra-procedural biopsy bleeding, re-bleeding within 30 days, and mortality. Secondary outcomes studied included procedure length, rate of H. pylori or cancer diagnosis, and patient follow up rate. Results: Our study included a total of 254 patients with UGIB, 171 had biopsies performed and 83 did not. Patients with more severe bleeding using Glasgow-Blatchford Bleeding Score and Rockall Score received less biopsies (p<0.001). There was no statistically significant association between both groups in length of procedure and 30-day mortality. There was an increase in intraprocedural bleeding and 30-day bleeding in the control group compared to those that received biopsies (p=0.011 and p=0.007 respectively). A multivariate analysis showed that patients that underwent biopsies were not associated with worse intraprocedural bleeding or 30-day rebleeding (p=0.043 and p=0.04). There was no difference in H-pylori incidence and cancer detection between the two groups. There were more patients that underwent biopsies who had surveillance than those in the control group (p=0.017). Conclusion: Gastric ulcer biopsies and random biopsies were found to be safe to obtain and did not increase the risk for intraprocedural bleeding, procedure length, 30-day rebleeding, rate of diagnosing cancerous lesion or H.pylori infections, or mortality rate. As EGD remains crucial in the diagnosis of many causes of UGIB, our study reinforces the importance of biopsies in the above-mentioned settings. This should not be postponed for the concern of worsening bleeding or increased mortality and can help ensure better outcomes by aiding diagnosis and management of UGIB.

PubMed ID

Not assigned.





First Page