{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:14:07Z","timestamp":1783682047323,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Acute esophageal variceal bleeding is a life-threatening gastrointestinal emergency associated with high morbidity and mortality. Endoscopy plays a central role in its management; however, the impact of off-hours endoscopic care on clinical outcomes remains controversial. This study aimed to compare regular-hours and off-hours endoscopic management in patients with acute esophageal variceal bleeding. Materials and Methods: This retrospective single-center cohort study included adult patients who underwent endoscopy for acute esophageal variceal bleeding between January 2020 and January 2025. Patients were divided into regular-hours and off-hours groups according to the timing of endoscopy. Demographic characteristics, laboratory findings, liver disease severity scores, endoscopy timing, and clinical outcomes were retrospectively evaluated. The primary endpoint was in-hospital mortality. Secondary endpoints were early rebleeding, length of hospital stay, and 6-week mortality. Results: A total of 253 patients were included; 160 (63.2%) underwent endoscopy during regular hours, and 93 (36.8%) during off-hours. Ascites was more frequent in the off-hours group (73.1% versus 58.8%; p = 0.022), and albumin levels were lower (2.7 versus 3.1 g\/dL; p = 0.024). The groups were similar in terms of age, sex, cirrhosis etiology, Child-Pugh-Turcotte class, and MELD-Na score. Most patients (90.3%) underwent endoscopy within 12 h, with no significant difference between groups. In-hospital mortality, 6-week mortality, early rebleeding, and length of hospital stay were also comparable. In multivariable logistic regression analysis adjusted for ascites, albumin level, and hepatic encephalopathy, off-hours endoscopic intervention was not independently associated with in-hospital mortality. Conclusions: Off-hours endoscopic management was not associated with worse mortality or rebleeding outcomes in acute esophageal variceal bleeding. These findings suggest that in well-organized centers with continuous endoscopy availability, clinical outcomes may be preserved regardless of the time of endoscopic intervention.<\/jats:p>","DOI":"10.3390\/medicina62071272","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:50:37Z","timestamp":1782867037000},"page":"1272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Off-Hours Endoscopic Management and Clinical Outcomes in Acute Esophageal Variceal Bleeding: A Real-World Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5388-794X","authenticated-orcid":false,"given":"Fatih","family":"K\u0131vrako\u011flu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2503-5846","authenticated-orcid":false,"given":"Abdullah","family":"\u0130lhan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5610-5376","authenticated-orcid":false,"given":"Duran Deha","family":"\u00c7etin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2314-2103","authenticated-orcid":false,"given":"Mustafa","family":"Har\u0131","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4062-7900","authenticated-orcid":false,"given":"\u0130brahim","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0957-7001","authenticated-orcid":false,"given":"B\u00fcnyamin","family":"Sar\u0131ta\u015f","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7288-3936","authenticated-orcid":false,"given":"\u015eehmus","family":"\u00d6lmez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Adana City Training and Research Hospital, Health Sciences University, 01230 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Nguyen, K.P., Van Nguyen, X., and Doan, T.H. 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