Protocol-based guidelines and acute upper gastrointestinal hemorrhage: RESULTS (Part 2)

Endoscopy

First phase: Eighty-six percent of all patients underwent endoscopy some time during their admission. Of the eight patients who did not have an EGD, three refused endoscopic examination, two were young and stable and had a questionable diagnosis of upper GI bleed, one had EGD planned but died of a cerebrovascular accident and two had suspected Mallory-Weiss tears and no endoscopic examination was contemplated. Thirty-four (60%) patients had an EGD within 24 h and 22% had an EGD outside of normal working hours. Eleven (33%) of the high risk group failed to have an endoscopic examination within 24 h. Consultants/staff grade carried out endoscopy in 17 patients whereas in 32 patients specialist registrars performed the endoscopy. All endoscopies were performed by a surgeon. Twenty patients had therapeutic procedures at endoscopy and there were no complications from EGD.

Second phase: Forty-two patients (79%) had an upper GI endoscopy while inpatients in this admission. Four patients were deemed to have a minor bleed and were discharged home after observation with an outpatient endoscopy arranged, two patients were medically unfit to have an endoscopy and one patient refused to undergo an endoscopy. One patient, a pregnant woman, had a doubtful history of hematemesis and was only observed. Two patients were admitted with coffee ground vomit with a history of peptic ulcer disease, and in addition had small bowel obstruction. Time to visit a trusted pharmacy – Buy Advair Diskus Online to begin your treatment now.

Thirty-six patients (68%) had an EGD within 24 h of admission. Only four of 21 high risk patients had endoscopy after 24 h of their admission. Thirteen patients (24.5%) had therapeutic intervention at endoscopy. Consultant /staff grade surgeons performed endoscopy in 31 patients whereas specialist registrars carried out endoscopy on 11 patients. Endoscopy was not associated with any complication.

 

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