Gastrointestinal bleeding diagnostic therapeutic assistance pathway: experience in a roman tertiary referral centre

Aims Acute gastrointestinal bleeding (GIB) is one of the most common medical emergencies, with an estimated mortality rates up 10-20%. The annual incidence of hospitalization ranges from 65-100/100000 people for upper GIB to 30-50/100000 for lower GIB. The management of haemorrhagic patients is complex and it requires specialized and multidisciplinary team. Endoscopic haemostatic treatment is recommended within 12-24 hours after presentation for patients with acute GIB. Limited data exist on clinical effect of medical care setting, suggesting a better outcome in pts treated in specialized centre [1] [2] [3] [4].

According to this, in 2020, we defined a GIB diagnostic therapeutic assistance pathway (PDTA), providing specialized care management in the emergency setting for these patients, also in order to facilitate their admission to Gastroenterology department (GD).

For this purpose we aimed to analyse GIB patients outcomes including rate of specialized hospitalization, mortality, length of stay, time to endoscopy, rate of endoscopic haemostasis, rebleeding and need for embolization or surgery.

Methods We collected data of all patients discharged from University Hospital Tor Vergata with a diagnosis GIB from 2020 to 2023. We further reviewed electronic reports of all emergency Gastroscopies (EGDS) made for upper GIB in the same period.

Results Between 2020 and 2023 among a total of 2888 GD hospitalizations 500 patients had a diagnosis of GIH (17%), compared with 72 patients (1,3%) among a total internal medicine department (IMD) admission of 5359 patients (p<0,01). Mean length of stay and mortality were 6 days and 1,23% (GD) vs 20 days and 5.5%(MD), but it’s necessary to consider the limits regarding the more complexity of IMD patients, which usual are older and more comorbid. A total of 187 patients underwent emergency gastroscopy for upper GIB in the study period, average haemoglobin was of 9 g/dl. Median time to EGDS was of 16 hours, with 100% of variceal bleeding patients receiving EGDS within 24 hours, of whom 77% within 12 hours. Endoscopic haemostasis was needed in 88 patients (49%) with 3 of them treated with over the scope clip as first line therapy for high risk ulcers. Rebleeding with further endoscopic haemostasis was needed in 19 patients (21%) with success, except for 1 patient who underwent embolization. None of the 3 patients treated with over the scope clip had rebleeding

Conclusions In our experience a dedicated gastrointestinal bleeding diagnostic therapeutic assistance pathway allowed to improve specialized management of patients, reducing mortality, length of stay and optimizing timing of endoscopy.

Publication History

Article published online:
27 March 2025

• References

• 1 Marmo R. et al Medical care setting is associated with survival in acute upper gastro-intestinal bleeding: A cohort study Dig Liver Dis. 2020.
• 2 Oakland K.. Changing epidemiology and etiology of upper and lower gastrointestinal bleeding Best Pract Res Clin Gastroenterol. 2019
• 3 Mullady DK. et al AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review Gastroenterology. 2020.
• 4 Gralnek IM. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Endoscopy.. 2015