AB240. SOH26AB_0191. Should we investigate every coffee-ground vomiting presentation?
General Posters III

AB240. SOH26AB_0191. Should we investigate every coffee-ground vomiting presentation?

Keely Long1, Mark Behan2, Catherine Cronin3, Hamid Mustafa3, Faisal Awan3, Osama Elfaedy3

1Faculty of Education and Health Services, School of Medicine, University of Limerick, Limerick, Ireland; 2Department of Surgery, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; 3Department of Surgery, St. Lukes General Hospital, Kilkenny, Ireland

Background: Coffee-ground vomiting (CGV) is often interpreted as a sign of upper gastrointestinal bleeding (UGIB), prompting urgent endoscopy. However, in elderly patients severely comorbid with complex polypharmacy, the true significance of CGV is unclear, particularly when other high-risk features are absent. We investigated if we should evaluate every CGV presentation.

Methods: We conducted a retrospective review of patients aged ≥70 years who underwent oesophagogastroduodenoscopy (OGD) for non-variceal UGIB, presenting as haematemesis or CGV between May 2022 and November 2024 at a tertiary centre (St. Lukes General Hospital). Clinical parameters and endoscopic findings were analysed.

Results: Analysis included 41 elderly patients (median age, 80 years) characterised by a heavy comorbidity burden; 90% had ≥2 comorbidities. Nine patients (22%) were on anticoagulation. Overall, 27% of the cohort had a significant endoscopic lesion, and the therapeutic intervention rate was 39%. CGV failed to reliably predict high-risk outcomes, demonstrating a 55% lower risk (relative risk =0.45) of requiring therapeutic intervention compared to haematemesis. The positive predictive value (PPV) of CGV was only 15% for identifying a significant lesion and 27% for predicting therapeutic need.

Conclusions: Our findings demonstrate that CGV alone is a poor indicator of severity in the elderly, confirming it as a significant driver of over-investigation. The low PPV (27%) for therapeutic need established that unselective OGD for CGV is a low-value practice that needlessly consumes resources, and that triage should prioritize objective risk assessment.

Keywords: Coffee-ground vomiting (CGV); elderly; endoscopy; upper gastrointestinal bleeding (UGIB); triage

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab240
Cite this abstract as: Long K, Behan M, Cronin C, Mustafa H, Awan F, Elfaedy O. AB240. SOH26AB_0191. Should we investigate every coffee-ground vomiting presentation? Mesentery Peritoneum 2026;10:AB240.

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