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The title of Professor Barkun's commentary on out of hours endoscopy1 caught my attention. He provides an excellent intelligible review of the evidence in favour of fairly early endoscopy for many patients who present with acute upper gastrointestinal (GI) haemorrhage, but he refers to cost only in linking early endoscopy to the potential for shorter hospital stays and so lower charges. I support the idea that suitably experienced endoscopists should be available out of hours to provide advice and endoscopy for patients who present with more severe GI haemorrhage just as colleagues in other specialities should be available to offer advice …
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