Introduction Endoscopy within 24 h of admission with acute upper GI bleeding (AUGIB) is associated with improved outcomes.1NICE guidance2recommends endoscopy to be available 24/7 but such standards are difficult to meet. A dedicated 8 until 9 am list has been suggested to minimise out-of-hours endoscopy.3An audit at PAH of AUGIB related massive transfusion protocol activations in 2011 and 2013 showed a reduction in mortality (from 10/19 to 0/3 mortality per activations) after implementing a dedicated list. This descriptive study analyses how this list has evolved and identifies areas for improvement.
Method We audited endoscopic procedures between 8–9 am on weekdays between the 22/12/2014 and 27/01/2015. Patient demographic, referral dates, indications and findings were analysed.
Results Fifty patients (mean age 73.5 range 20.7– 93.5, 60% male) were audited (86% OGD, 24% flexible sigmoidoscopy, FS). Twelve percent of procedures (4 OGD 2 FS) were cancelled because of haemodynamic instability (2/6), low SpO2 (1/6), inappropriate palliative patient (1/6), non-consent (1/6) and no MCA2 declaration (1/6). Mean time between referral and procedure was 2.5 days (range 1–13). Procedures were done within 24 and 48 h after referral in 48% and 80% of the time, respectively, while 50% suspected UGI bleeds had an OGD within 24 h. OGD referrals were for assessment of suspected UGIB (72%), dysphagia (12%), varices screening (7%) and dyspepsia (6%). Endotherapy was performed in 23%. A probable cause for UGIB was found in 44%, blood in upper GI tract in 11% and haemostatic endotherapy was delivered in 22%. In those with dysphagia, oesophageal stricturing (3/5, 2 requiring dilatation), post-oesophagectomy (1/5) and oesophagitis (1/5) were seen.
Conclusion This list allows an average of 2 extra procedures to be performed daily, without interrupting elective work. Since over 10% of patients are sent back to wards we propose optimising use of list capacity. We report similar waiting times for suspected UGIB to other UK endoscopy units, although still not in line with NICE recommendations. Around 1 in 5 patients required endotherapy. We suggest that our current endoscopy referral triage to an early morning endoscopy list effectively manages AUGIB locally but could be optimised by improving time to endoscopy in suspected AUGIB and decreasing non ultilisation rates.
Disclosure of interest None Declared.
Chak A, et al. Effectiveness of endoscopy in patients admitted to the intensive care unit with upper GI hemorrhage. Gastrointest Endosc. 2001;53:6–13
NICE Guideline:Acute upper gastrointestinal bleeding:management, CG141, June 2012
Provision of Endoscopy Related Services in District General Hospitals. BSG Working Party Report 2001
Acute Upper Gastrointestinal Bleeding:An overview of out of hours service provision and equity of access. NHS Improving Quality/BSG, January 2014
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