Endoscopy 2020; 52(S 01): S253
DOI: 10.1055/s-0040-1704794
ESGE Days 2020 ePoster presentations
Thursday, April 23, 2020 09:00 – 17:00 Clinical endoscopic practice ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

ACUTE UPPER GASTROINTESTINAL BLEEDING AT A ‘HOT’ SITE – WHAT FACTORS INFLUENCE ENDOSCOPY?

R Patel
1   Royal Free London NHS Trust, London, United Kingdom
,
S Moledina
1   Royal Free London NHS Trust, London, United Kingdom
,
R Cama
1   Royal Free London NHS Trust, London, United Kingdom
,
K Besherdas
1   Royal Free London NHS Trust, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims Acute upper gastrointestinal bleeding (AUGIB) is a medical emergency with a 10% mortality risk. Dividing endoscopy services into two separate sites: elective (‘cold’ site) and emergency (‘hot’ site) is a novel approach that avoids competition for endoscopy slots, thus optimising patient outcomes. We aimed to describe time to endoscopy and outcomes at an exclusively ‘hot site’ and identify predictors of delayed endoscopy (> 24 hours).

Methods Retrospective study of all emergency gastroscopies performed at a ‘hot’ London-based endoscopy site between 6/9/2018 – 8/5/2019. The ‘hot’ site provisions a session of endoscopy dedicated to inpatients during Monday to Friday, and on-call emergency theatre access during weekends if required. No elective endoscopies are performed at this unit. A decision tree classifier was used to select features contributing to delayed endoscopy and a multiple logistic regression model utilized these shortlisted factors to assign values of importance with regard to delayed endoscopy.

Results 151 gastroscopies were performed during the study period (132 new admissions (87.4%), 19 in-hospital bleeds (12.6%)). 55% of patients had an endoscopy within 24 hours.

Tab. 1

Endoscopy times: Admission vs Inpatient AUGIB

Admission with suspected AUGIB

Inpatient suspected AUGIB

p-value

Mean Time to endoscopy (hours)

34.1 (Range: 1.8–175.2)

49.5 (Range: 1.1–336.1)

0.03

Multiple logistic regression found that patients admitted with anaemia (p < 0.001, OR 1.54) and weekend admissions (p < 0.005, OR 1.34) were independent predictors for delayed endoscopy.

Conclusions Almost 90% of emergency gastroscopies at our ‘hot’ site are performed for direct AUGIB admissions. Those admitted with suspected AUGIB undergo endoscopy sooner than those with an inpatient bleed. Primary presentation with anaemia and weekend admissions are associated with delayed endoscopy. The majority of patients at our exclusively ‘hot’ site did not have a delayed endoscopy.