The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium  UTJMS 2023 April 19; 11:e1-e2  
 

https://dx.doi.org/10.46570/utjms.vol11-2023-681   
 

Early Feeding Versus Delayed Feeding 
after Therapeutic Endoscopic Intervention 
in Upper GI Bleeding: A Systematic Review 
and Meta-analysis 
 
Wasef Sayeh, MD1*, Azizullah Beran, MD1, Sami Ghazaleh, MD2, Mohammad Safi, 
MD1, Brayyana Jay, MD1, Sabeen Sidiki, MD1,  Amna Iqbal, MD1, Ziad Abuhelwa, 
MD1, Waleed Khokher, MD1, Sara Stanely, DO2, Ajit Ramadugu, MD2, Ali Nawras, 
MD2 
 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 
 
*Corresponding author: wasef.sayeh@utoledo.edu  
 
Published: 19 April 2023 
 

Introduction: Multiple endoscopic interventions are used to treat upper GI bleeding. Early feeding after 
endoscopic intervention in upper GI bleeding was always thought to be associated with higher mortality 
rate and worse outcomes. 

 

Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and 
the Cochrane Central Register of Controlled Trials from inception through May 25th, 2022. We 
considered only randomized controlled trials. The primary outcome was the mortality rate. The 
secondary outcomes were the occurrence of early bleeding, late bleeding and the length of hospital stay. 
The random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and 
confidence intervals (CI).   

 

Results: Eight randomized controlled trials involving 818 patients were included in the meta-analysis. 
The mortality rate was not statistically different between the two groups (RR 0.60, 95% CI 0.32-1.14, p 
=0.12, I2 = 0%) (Figure 1a). Also, the rates of both early and late bleeding were not statistically different 
(RR 1.17, 95% CI 0.60-2.26, p =0.64, I2 = 0%) and (RR 0.74, 95% CI 0.25-2.14, p =0.58, I2 = 17%), 
respectively.  The length of hospital stay was significantly shorter in the early feeding group (MD -0.99 
days, 95% CI -1.15- -0.83, p <0.00001, I2 = 70%) (Figure 1b).  

 

https://dx.doi.org/10.46570/utjms.vol11-2023-681
mailto:wasef.sayeh@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-681  UTJMS 11(1):e1-e2    

https://dx.doi.org/10.46570/utjms.vol11-2023-681  2 ©2023 UTJMS  
 

  
 

Discussion: Our meta-analysis demonstrated that early feeding after endoscopic interventions in patients 
with upper GI bleeding appears to be relatively safe. There was no statistical difference in mortality rates 
and in early or late bleeding rates. Moreover, it was associated with a shorter hospital stay. 

https://dx.doi.org/10.46570/utjms.vol11-2023-681
https://dx.doi.org/10.46570/utjms.vol11-2023-681