Background/Objectives: Dose escalation has been commonly used to achieve and maintain response. We aimed to compare the outcomes of adalimumab or infliximab dose escalation in inflammatory bowel disease (IBD) patients. Methods: Treatment persistence (TP) and predictive factors for remission-free treatment discontinuation (r-fTD) were evaluated in patients treated with adalimumab or infliximab dose escalation between 2019 and 2024. Results: Dose escalation was identified in 142 patients treated with adalimumab (UC: 23.9%; CD: 76.1%) and in 126 patients treated with infliximab (UC: 23.8%; CD: 76.2%). The TP rate was significantly lower in the adalimumab group (35.2%) than the infliximab group (53.2%) (p = 0.003). The survival analysis showed that drug persistence was lower in the adalimumab group compared with the infliximab group (mean time: 74.3 vs. 99.5 months, p < 0.001). TP rates showed no significant differences between UC and CD for both adalimumab (mean time UC: 64.7 months vs. CD: 76.2 months, p = 0.403) and infliximab (mean time UC: 80.3 months and CD: 102.6 months, p = 0.151). The r-fTD rates were significantly higher in the adalimumab group (62.7%) than the infliximab group (39.7%) (p < 0.001). Primary lack of response and secondary loss of response (sLOR) rates were both higher in the adalimumab group (7.7% and 51.4%) than the infliximab group (1.6% and 28.6%). However, serious adverse events were lower in the adalimumab group (2.1%) than the infliximab group (7.9%) (p = 0.027). Conclusions: Infliximab dose escalation was more effective than adalimumab in both UC and CD patients. Regarding the side effect profile, adalimumab dose escalation was found to be safer compared with infliximab.

Abstract Background Crohn’s Disease (CD) may be overlooked in patients presenting to the emergency department with acute abdominal pain. We aimed to determine the frequency of CD and increased terminal ileum wall thickness on abdominal computed tomography (CT) in patients presenting to the emergency department with non-traumatic acute abdominal pain. Methods A cross-sectional observational study was conducted among patients who had presented to the emergency department with non-traumatic acute abdominal pain and underwent CT between September 2023 and September 2024. Before CT, patients with known diseases such as CD, vasculitis, tuberculosis, and lymphoma were excluded from the study. A colonoscopy was performed on patients with terminal ileum wall thickness on CT examination. Results A total of 1014 patients were admitted to the emergency department with non-traumatic acute abdominal pain, 10 (1%) of whom were determined to increase terminal ileum wall thickness. The median age was 41.2, and 7 (70%) patients were female. Median terminal ileum wall thickness was measured as 6.04 mm. 9 (90%) had limited terminal ileum, 6 (60%) had a length of wall thickness more than > 5cm, 7 (70%) had stenosis and 5 (50%) had pre-stenotic dilatation on CT. Colonoscopy revealed aphthous ulcers in the terminal ileum in 6 patients, longitudinal deep ulcers in 2 patients, and 2 patients with intact terminal ileum mucosa. 3 (0.3%) of the patients with terminal ileum wall thickness were diagnosed CD after colonoscopic examination. One patient had ileocolonic involvement with stricturing behavior, while the other two had isolated ileal involvement with inflammatory behavior. 2 patients were managed with medical treatment and the other patient with ileal resection. The remaining 5 patients with terminal ileal aphthous ulcers had a history of antibiotic, nonsteroidal anti-inflammatory drug use, or gastroenteritis within the last 3 months. Conclusion In this study, CD was detected in 3 (0.3%) patients who has previously undiagnosed, presented non-traumatic acute abdominal pain with terminal ileum wall thickness on CT. Terminal ileitis is a rare reason in patients presenting acute abdominal pain. However, CD should be kept in mind among differential diagnosis.

Abstract Background Treatment of inflammatory bowel disease (IBD) is challenging due to the maintenance of remission and associated fetal safety concerns during pregnancy. While existing literature emphasizes the importance of achieving remission prior to conception, optimal management of IBD during pregnancy remains underexplored, especially regarding medication continuation and efficacy. Methods This cross-sectional study was performed in pregnant patients with IBD between March 2019 and June 2023. Clinical features, treatment details, disease activation and outcomes were collected and analyzed. Results A total of 57 pregnant were included, of those 37 (64.9%) had UC, and 20 (35.1%) had CD. The overall median disease duration was 9.1 (6-12.8) years (8.2 years for UC and 9.9 years for CD). The disease location was 19 (51.4%) left-sided colitis, 15 (40.5%) extensive, and 3 (8.1%) proctitis in UC, while in CD 8 (40%) patients were ileal involvement, 8 (40%) ileocolonic and 4 (20%) colonic. 4 (20%) had stricturing disease and 4 (20%) had penetrating disease in CD. Before pregnancy, medical treatments for UC patients were mesalazine in 29 (78.4%) patients, thiopurine in 20 (54.1%), biologic therapy in 6 (16.2%), while it was 13 (65%) patients biologic therapy and 7 (35%) thiopurine in CD patients. The most prescribed biologic agent was infliximab in both diseases. During pregnancy, 16 (28.1%) patients [6 (18.8%) with UC and 10 (50%) with CD] had a history of drug withdrawal. 13 (%81) medications were withdrawn by the patient's wish. Disease activation occurred in 25 (43.9%) patients, 10 (50%) with CD, and 15 (40.5%) with UC. 12 (48%) patients required steroids due to activation. There were 54 (94.7%) live births when compared based on whether disease activation developed or not, there was no statistically significant difference in live birth rate 23, 92% vs. 31, 96.9%, p=0.576. There was no statistically significant difference between normal birth and cesarean section rates with activation development. 3 (5%) abortions occurred. Abortion rate was not associated with disease activation (p>0.05). No serious infection occurred during the first month following birth. Conclusion In this study, the disease activation was seen in 43.9% of pregnant patients with IBD. Consistent medication management of IBD during pregnancy enhances patient adherence, reduces risks, and promotes positive maternal outcomes. Proactive counseling and careful selection of medications are crucial for disease control and optimizing pregnancy outcomes in IBD patients.

Abstract Background Intestinal ultrasound (IUS) scoring systems have been developed to detect disease activity in patients with ulcerative colitis (UC). Nevertheless, further and comparing studies IUS scores to evaluate disease activity in UC patients are needed. We aimed to compare 2 existing validated scores, the Milan Ultrasound Criteria (MUC) and Ulcerative Colitis Intestinal Ultrasound (UC-IUS) index, for evaluating disease activity in patients with UC. Methods An observational cross-sectional study was performed in adult UC patients between November 2019 and June 2024. All UC patients underwent IUS before a day colonoscopy, and endoscopic Mayo score ≥2 was accepted as an active disease. Results Total 62 adult patients with UC (median age: 39 years) were included in the study, 39 (62.9%) patients were male, the median age was 39 years and the median duration of the disease was 6.32 (IQR, 2.63-12.32) years. Extensive location was the most prevalent extension 39 (62.9%) among all patients. The median MUC was 8.42 (IQR, 6.34-10.96) and the median UC-IUS index was 5 (IQR, 4-6.25) for all UC patients. In patients with endoscopically remission group (endoscopic Mayo score <2), which include 14 (22.6%) patients, the median MUC was 5.76 (IQR, 3.61-6.8) and the median UC-IUS index was 3 (IQR, 2-4). Nevertheless, in endoscopically active group, the median MUC was 9.14 (IQR, 7.6-11.63) and the median UC-IUS index was 6 (IQR, 4-7), MUC and UC-IUS index were higher in endoscopic active group than in remission group (p< 0.001). Furthermore, the clinically active group (partial Mayo score ≥5) had greater MUC and UC-IUS index than the clinically remission group (p< 0.005 and p< 0.001, respectively). The cut-off value for MUC to predict endoscopic activity (endoscopic Mayo score ≥2) was 7.46 (AUC: 0.906, 95% CI: 0.830-0.983, sensitivity: 81%, specificity: 86%, p < 0.001), and the cut-off value for UC-IUS index to expect endoscopic activity was 4.5 (AUC: 0.846, 95% CI: 0.739-0.953, sensitivity: 71%, specificity: 86%, p < 0.001). Conclusion In this study, we found that MUC and UC-IUS index demonstrates a strong correlation with the endoscopically active UC patients. The most accurate cut-off value for MUC was 7.6 and the most accurate cut-off value for UC-IUS index was 4.5 in UC patients with endoscopically active group.

AIM:Periampullary diverticulum (PAD) is a common anatomical variant that can potentially impact the technical difficulty and outcomes of endoscopic retrograde cholangiopancreatography (ERCP), necessitating a comprehensive understanding of its effects on the procedure. To evaluate the effect of PAD subtypes and diameter on ERCP cannulation success and clinical outcomes. MATERIALS AND METHODS:The study included patients with PAD and papilla-naïve patients undergoing ERCP for suspected common bile duct stones or distal benign strictures (due to PAD compression). PAD subtyping was based on Lobo and Li-Tanaka classifications. Diverticulum size was categorized as small (<1 cm), medium (1-2 cm), and giant (≥2 cm). RESULTS:Of the 907 patients analyzed, 164 (18%) had PAD with a median age of 63 years. PAD patients were significantly older than non-PAD patients and had more comorbidities. The most frequent PAD type was 2B (34.1%) based on the Li-Tanaka classification. Subgroup analysis of PAD types 1, 2, 3, and 4 showed no statistically significant differences in cannulation time, success, total procedure time, or adverse events (AEs). Overall cannulation success rates were similar between PAD and non-PAD groups (99.4% vs 99.6%). Analysis based on diverticulum size revealed higher probabilities of giant stones and procedure-related AEs in giant diverticula. The risk of post-ERCP pancreatitis was notably low at 1.8% in the PAD group. CONCLUSION:Diverticulum size, rather than PAD subtype, may be more closely associated with cannulation success and procedure-related AEs in ERCP. Individualized management considering diverticulum size may improve outcomes in PAD patients undergoing ERCP.

BACKGROUND AND AIM:We aimed to compare two main existing scores, the Bowel Ultrasound Score (BUSS) and the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) to predict simplified endoscopic activity score for Crohn's disease (SES-CD). METHODS:A cross-sectional study was conducted to evaluate the disease activity in Crohn's disease (CD) patients with ileal involvement between November 2019 and February 2024. Endoscopic remission for CD was accepted as SES-CD ≤2. RESULTS:A total of 56 adult patients with CD (male: 38, 68%, median age: 40.5 years) were included in the study, the median duration of the disease was 8.4 years. The cutoff value for BUSS to determine endoscopic remission was 3.9, whereas the cutoff value for IBUS-SAS to establish endoscopic remission was 24.4. BUSS and SES-CD had a strong positive correlation ( P  < 0.001), BUSS and IBUS-SAS had a high positive correlation ( P  < 0.001), and BUSS and C-reactive protein had a slightly positive correlation ( P  < 0.001). CONCLUSION:This study revealed that the cutoff values for BUSS and IBUS-SAS in CD patients with endoscopic remission were 3.9 and 24.4, respectively. Furthermore, it was demonstrated that BUSS and IBUS-SAS highly correlate with endoscopic activity in the real-world cohort.

Objectives: The current study compared potential risks, complications, and the impact on clinical outcomes among elderly and younger patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: Procedure-related complications, risk factors, and clinical outcomes following complications in elderly patients (aged ≥75 years) and younger who underwent biliary ERCP were evaluated. Results: Median age of 63 (48–74) of 1164 patients who underwent biliary ERCP for the first time, and 266 (22.8%) were elderly. Comorbidities were statistically significant (81 [30.5%] versus 78 [8.7%], p < 0.001), and periampullary diverticulum (PAD) was detected more commonly in the elderly group (79 [29.7%] vs. 103 [11.5%], p < 0.001). There was no statistical difference in cannulation technique, cannulation time, and cannulation success in both groups, while the total ERCP procedure time was higher in the elderly group (22 [16–29] vs. 20 [14–29], p = 0.030). Regarding the procedure-related complications, there was no statistically significant difference between the two groups (26 [9.8%] vs. 71 [7.9%], p = 0.292). In the case of complications, the length of hospitalization stay was statistically longer in the elderly group. Moreover, the elderly had a longer length of hospitalization, experiencing pancreatitis and a higher probability of developing moderate/severe pancreatitis. In multivariate and univariate analysis, prolonged cannulation time was found to be an independent risk factor in patients ≥75 years of age. Conclusions: This study showed that while ERCP-related complication rates in elderly patients are comparable to younger patients, it can be associated with worse outcomes following the complication and prolonged length of hospitalization.

To evaluate the optimal endoscopy time in elderly patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) based on clinical outcomes. Patients over 65 years of age presenting with NVUGIB are three patient groups based on endoscopy timing: very early endoscopy (< 12 h), early endoscopy (12–24 h) and late endoscopy (> 24 h). Endoscopic intervention was undertaken during the first 12 h for patients who had unstable hemodynamic settings, ongoing bleeding, or a low hematocrit despite transfusion. The clinical outcomes investigated were: The primary endpoint was 30-day mortality, with the need for endoscopic intervention, rebleeding, and length of hospital stay considered as secondary endpoints. The study population was 468, 260 of whom were ≥ 65 years. Based on the timing of endoscopy, very early endoscopy (within 12 h) was performed in 180 (69.2

Abstract Background In this study, we aimed to evaluate the demographic and epidemiological trends of Ulcerative Colitis (UC) and Crohn’s Disease (CD) in non-endemic era for inflammatory bowel disease (IBD) during the past three decades. Methods UC and CD patients who had follow-up at least 6 months between June 1993 and February 2023 were evaluated retrospectively. Electronic medical databases, personal queries and IBD registries have all been used to collection data on the clinical and demographic characteristic of all patients. Results A total of 1549 adult patients with UC and CD were admitted to study. UC was diagnosed in 873 (56.4%) patients (Male 538, 61.6%) and CD was diagnosed in 676 (43.6%) patients (Male 404, 59.8%). The median follow-up duration was 8.3 years for UC patients and 6.8 years for CD patients. In patients with UC, proctitis was 154 (17.6%), left sided colitis was 410 (47%) and extensive colitis was 309 (35.4%). In CD patients, ileal involvement was found in 297 (43.9%), colonic in 76 (11.2%), ileo-colonic in 299 (44.2%) and isolated upper GI involvement in 4 (0.6%) cases. 529 (78.3%) patients had non-stenosing non-penetrating behavior, 45 (6.7%) had stenosing behavior, 102 (15.1%) had penetrating behavior, as well as 196 (29%) patients had perianal disease. Mesalazine 658 (75.4%) and thiopurine 397 (45.5%) were the most frequently used conventional treatments for UC, while thiopurine 304 (45%) was most commonly used for CD patients. In the last two-decade, proportion of the biologic usage were 27.9% and 32.1% in UC patients 28.5% and 31.4% in CD patients respectively. Over the three decades, abdominal surgery was 49.2%, 27.8% and 36.3% in CD and colectomy rates was 2.0%, 2.7% and 3.7% in UC patients. While the rate of UC patients has slightly decreased to 98 (61.6%), 401 (58.5%) and 374 (53%) frequency of CD patients has increased to 61 (38.4%), 284 (41.5%) and 331 (47%). Over the course of three decades, there were more UC patients than CD patients, however proportion of UC/CD has been continuously decreased (1.61, 1.41 and 1.13) for three decades respectively. Conclusion Our study showed that the frequency of UC and CD has significantly increased during the previous three decades in non-endemic era for IBD. While the frequency of UC patients has slightly decreased, that of CD patients has steadily increased over the past three decades. Although the use of biologics has significantly increased, proportions of the abdominal surgeries and colectomies has not prominently changed.

Aims: In this study, we aimed to evaluate the demographic and epidemiological trends of ulcerative colitis (UC) and Crohn’s disease (CD) in non-endemic era for inflammatory bowel disease (IBD) during the past three decades. Methods: UC and CD patients who had follow-up at least 6 months between June 1993 and February 2023 were evaluated retrospectively. Electronic medical databases, personal queries and IBD registries have all been used to collection data on the clinical and demographic characteristic of all patients. Results: A total of 1549 adult patients with UC and CD were admitted to study. UC was diagnosed in 873 (56.4%) patients (male 538, 61.6%) and CD was diagnosed in 676 (43.6%) patients (male 404, 59.8%). Median total disease duration was 8.3 years in UC group, as well as 6.8 years in CD group. In patients with UC, proctitis was 154 (17.6%), left sided colitis was 410 (47%) and extensive colitis was 309 (35.4%). In CD patients, ileal involvement was found in 297 (43.9%), colonic in 76 (11.2%), ileo-colonic in 299 (44.2%) and isolated upper gastrointestinal involvement in 4 (0.6%) cases. 529 (78.3%) patients had inflammatory disease (non-stenosing non-penetrating behavior), 45 (6.7%) had stenosing behavior, 102 (15.1%) had penetrating behavior, as well as 196 (29%) patients had perianal disease. Mesalazine 658 (75.4%) and thiopurine 397 (45.5%) were the most frequently used conventional treatments for UC, while thiopurine 304 (45%) was most commonly used for CD patients. In the last two-decade, proportion of the biologic usage were 27.9% and 32.1% in UC patients 28.5% and 31.4% in CD patients respectively. Over the three decades, abdominal surgery was 49.2%, 27.8% and 36.3% in CD and colectomy rates was 2.0%, 2.7% and 3.7% in UC patients. While the rate of UC patients has slightly decreased to 98 (61.6%), 401 (58.5%) and 374 (53%) frequency of CD patients has increased to 61 (38.4%), 284 (41.5%) and 331 (47%). Over the course of three decades, there were more UC patients than CD patients, however proportion of UC/CD has been continuously decreased (1.61, 1.41 and 1.13) for three decades respectively. Conclusion: Our study showed that the frequency of UC and CD has significantly increased during the previous three decades in non-endemic era for IBD. While the frequency of UC patients has slightly decreased, that of CD patients has steadily increased over the past three decades. Although the use of biologics has significantly increased, proportions of the major abdominal surgeries and colectomies has not prominently changed.

Background: Oral manifestations of Crohn’s disease (CD) include non-specific lesions and specific lesions directly related to intestinal inflammation. Oral lesions that can be overlooked in CD are sometimes challenging to treat. Methods: In this retrospective single-center study, patients with CD aged over 18 years who complied with follow-up and treatment were included. Clinical definitions of specific oral lesions included pyostomatitis vegetans, glossitis with fissuring, lip swelling with fissuring, cobblestoning, and orofacial granulomatosis. Experienced dentists confirmed the specific lesions in each case. Three groups of patients were identified: those without oral lesions, those with non-specific oral lesions, and those with specific oral lesions. The groups were compared based on demographics, disease extent and behavior (based on the Montreal classification), extraintestinal involvement, biologic and steroid treatment, and the requirement of resective surgery. Results: A total of 96 patients (14.2%) with oral lesions were found among the 676 patients with CD (59.7% male, median age 38 years) who were followed for 6.83 years (IQR 0.5–29.87 years). Eight patients (1.2%, 9 lesions) had specific oral lesions, while eighty-eight patients (13%) had non-specific lesions. Orofacial granulomatosis (n = 3), cobblestoning (n = 2), glossitis with fissuring (n = 2), and lip swelling with fissuring (n = 2) were among the specific lesions. The majority of patients (75%) with specific lesions were male, and their median age was 46.5 years (range: 23–68 years). Disease localization was commonly ileocolonic (50%), and perianal disease was present in 25% of patients. Three patients were active smokers. Extraintestinal manifestations were peripheral arthritis/arthralgia (n = 7) and sacroiliitis (n = 1). All specific lesions were associated with moderate-to-severe disease. Five patients improved with biologic therapy, and two patients with immunomodulatory therapy. Conclusions: Specific oral lesions in CD were associated with active disease and improved with immunomodulators or biologic therapy. Close cooperation between gastroenterologists and dentists is essential for early diagnosis and optimal management of CD.

Drug-induced autoimmune hepatitis (DI-AIH) is a condition that mimics autoimmune hepatitis both histologically and clinically, making diagnosis challenging. Ribociclib, a CDK4/6 inhibitor used in the treatment of metastatic breast carcinoma, has been associated with rare cases of DI-AIH. We present the case of a 46-year-old woman undergoing treatment with ribociclib for metastatic breast carcinoma, who developed fatigue, skin rash, and significantly elevated liver enzymes two months into therapy. Initial tests revealed ALT of 414 U/L and AST of 219 U/L, along with elevated IgG levels and positive antinuclear antibodies. A liver biopsy showed chronic active hepatitis with mixed inflammatory cell infiltrates, including plasma cells and eosinophils. Despite the discontinuation of ribociclib, the liver enzymes remained elevated, necessitating treatment with prednisolone and azathioprine. Over the course of six months, the patient's liver function improved, and immunosuppressive therapy was gradually tapered off. This case highlights the importance of recognizing ribociclib-induced DI-AIH and the effectiveness of immunosuppressive therapy in managing persistent liver injury.

BACKGROUND/AIMS:Non-variceal upper gastrointestinal bleeding is a well-established complication of non-steroidal anti-inflammatory drugs and anti-thrombotics. Both medication groups are frequently used by older populations and increase the incidence of non-var- iceal upper gastrointestinal bleeding; however, their impact on etiology and outcomes of non-variceal upper gastrointestinal bleeding has not been well defined. We aimed to compare the etiology and outcomes of non-variceal upper gastrointestinal bleeding in older patients who use anti-thrombotics and non-steroidal anti-inflammatory drugs or do not use either of them.MATERIALS AND METHODS:This is a single-center prospective study of patients older than 65 years with non-variceal upper gastrointesti- nal bleeding. Endoscopic findings, laboratory values, blood transfusion, endoscopic treatment, re-bleeding, and 30-day mortality rates were recorded.RESULTS:A total of 257 patients (median age 77.7 ± 8.2, 59% male) were included. Re-bleeding occurred in 25 (10%) and the 30-day mortality rate was 40 (16%). There was no statistically significant difference between patients using anti-thrombotics, non-steroidal anti-inflammatory drugs or non-users for blood transfusion (P = .46), endoscopic hemostasis (P = .39), re-bleeding (P = .09), and 30-day mortality (P = .45). Peptic ulcer was the most common etiology in all groups (124, 48%). Although the incidence of peptic ulcer was similar between drug users and anti-thrombotic users (P = .75), the incidence of peptic ulcer was significantly higher in patients using non-steroidal anti-inflammatory drugs than in patients who did not use drugs (P = .05). When the patients were analyzed as using anti- thrombotic drugs or non-steroidal anti-inflammatory drugs or neither, no statistically significant difference was found between ulcer location, ulcer number, and ulcer size.CONCLUSION:Non-variceal upper gastrointestinal bleeding increasingly occurs in older populations with several comorbidities; non- steroidal anti-inflammatory drugs or anti-thrombotics do not seem to change the clinical outcomes among older patients with non- variceal upper gastrointestinal bleeding.

OBJECTIVE:Long-term comparison studies between infliximab (IFX) and adalimumab (ADA) with or without immunomodulator therapy are still needed in Crohn's disease (CD). In this study, we evaluated IFX and ADA for long-term clinical effectiveness and safety in CD patients who had not previously received a biologic treatment.PATIENTS AND METHODS:The data of adult CD patients were collected retrospectively between December 2007 and February 2021. We compared CD-related hospitalization, CD-related abdominal surgery, steroid use, and serious infections.RESULTS:Out of 224 CD patients, 101 started IFX first (median age: 38.12 years, 61.4% male), while 123 started ADA first (median age: 30.2 years, 64.2% male). The disease durations were 7.01 years and 6.91 years for IFX and ADA, respectively. There were no significant differences between the two groups with respect to age, gender, smoking, immunomodulator usage, and disease activity score at the onset of anti-TNF therapy (p>0.05). Overall, the median follow-up time was 2.36 and 1.86 years after starting anti-tumor necrosis factor-alpha (anti-TNF) therapy in the IFX and ADA groups, respectively. Steroid use (4.0% vs. 10.6%, p=0.109), hospitalization for CD (13.9% vs. 22.8%, p=0.127), abdominal surgery for CD (9.9% vs. 13.0%, p=0.608), and major infections (1.0% vs. 0.8%, p>0.999) did not differ significantly from one another. There were also no significant differences in the rates of these outcomes between concomitant immunomodulator therapy and monotherapy (p>0.05).CONCLUSIONS:In this study, we observed no significant differences in the long-term effectiveness and safety of IFX and ADA in biologic-naïve patients with CD.

Objective: Data regarding early (within 24 h) and urgent endoscopy (within 12 h) in non-variceal upper gastrointestinal bleeding (NV-UGIB) revealed conflicting results. This study aimed to investigate the impact of endoscopy timing on the outcomes of high-risk patients with NV-UGIB. Patients and methods: From February 2020 to February 2021, consecutive high-risk (Glasgow-Blatchford score >= 12) adults admitted to the emergency department with NV-UGIB were analyzed retrospectively. The primary composite outcome was 30-day mortality from any cause, inpatient rebleeding, need for endoscopic re-intervention, need for surgery or angio-graphic embolization. Results: 240 patients were enrolled: 152 (63%) patients underwent urgent endoscopy (<12 h) and 88 (37%) patients underwent early endoscopy (12-24 h). One or more components of the composite outcome were observed in 53 (22.1%) patients: 30 (12.5%) had 30-day mortality, rebleeding occurred in 27 (11.3%), 7 (2.9%) underwent endoscopic re-intervention, and 5 (2.1%) required surgery or angiographic embolization. The composite outcome was similar between the groups. Multivariate analysis showed only hemodynamic instability on admission (OR: 3.05, p = 0.006), and the previous history of cancer (OR: 2.42, p = 0.029) were significant in predicting composite outcome. In terms of secondary outcomes, the endoscopic intervention was higher in the urgent endoscopy group (p = 0.006), whereas the number of transfused erythrocyte suspensions and the length of hospital stay was higher in the early endoscopy group (p = 0.002 and p = 0.040, respectively). Conclusions: Urgent endoscopy leads to a significant reduction in the length of hospitalization and the number of transfused erythrocyte suspensions in NV-UGIB, which can contribute to patient satisfaction, reduce healthcare expenditure, and improve hospital bed availability. Thecomposite outcome and its sub-outcomes were the same among both groups. (c) 2022 Elsevier Espana, S.L.U. All rights reserved.