Dig Liver Dis. 2016 Oct;48(10):1180-6. doi: 10.1016/j.dld.2016.07.009.

A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study. 

Horibe M1, Kaneko T2, Yokogawa N3, Yokota T4, Okawa O4, Nakatani Y4, Ogura Y4, Matsuzaki J5, Iwasaki E5, Hosoe N6, Masaoka T5, Inadomi JM7, Suzuki H8, Kanai T5, Namiki S4.
The mortality rate in cases of upper gastrointestinal bleeding (UGIB) is 10-14%, and guidelines recommend that patients with UGIB undergo an endoscopy within 24 hours of hospital admission.1-3 However, performing an emergent endoscopy for all UGIB patients is difficult. Although the Glasgow Blatchford Score (GBS) assesses the risk of UGIB before endoscopy, it is not suitable for predicting an emergent endoscopy because it was developed to predict composite outcomes (blood transfusion, endoscopic treatment, surgery, or death). 4 We therefore developed the Simple Emergent Endoscopy (SEE) score to determine if patients with suspected UGIB should undergo an emergent endoscopy. SEE assesses both variceal and non-variceal bleeding, an important point given that the source of the hemorrhage is unknown when the decision to perform an emergent endoscopy is made.
Figure 1: New management of suspected upper gastrointestinal bleeding by Simple Emergent Endoscopy(SEE) score

SEE score consists of three variables, namely, “no daily use of proton pump inhibitor during one week before examination (+1),” “shock index (heat rate/systolic blood pressure) ≥1 (+1),” and “Urea/Creatinine≥140 (Blood urea nitrogen/Creatinine ≥30) (+1)”. (Figure 1) The range is 0 to 3 points, making the SEE score much simpler to use than the GBS, which contains eight complicated variables and a range of 0 to 23 points.4 Despite its simplicity, the SEE score has significantly greater accuracy (AUC: 0.74) for predicting the need for an endoscopic intervention than the GBS (AUC: 0.63) (p<0.001). Moreover, the continuous net reclassification improvement (NRI) was 0.57 (p<0.001) and the integrated discrimination improvement (IDI) was 0.15 (p<0.001). Furthermore, the SEE score (AUC: 0.76) performs just as well as the full Rockall score (AUC: 0.76) (p=0.65).

Table 1 shows the SEE score and the outcomes including additional data (from 2008 to 2016). These results show that an emergent endoscopy is required when the SEE score is 2 or 3 while patients with a score of zero could be managed as outpatients as they are less likely to have high-risk stigmata. The SEE score is easy and clinically useful in the management suspected UGIB.


Table 1: Simple Emergent Endoscopy (SEE) Score and outcome


1. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152(2): 101-13.
2. Sung JJ, Chan FK, Chen M, et al. Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding. Gut 2011; 60(9): 1170-7.
3. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol 2012; 107(3): 345-60; quiz 61.
4. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000; 356(9238): 1318-21.