Time to Endoscopy in Patients Presenting with an Upper Gastrointestinal Bleed at a Tertiary Endoscopy Centre in Ireland

Aims The European Society of Gastrointestinal Endoscopy (ESGE) recommends early endoscopy in both nonvariceal [1] (< 24 hours) and variceal [2] (< 12 hours) bleed presentations. However, despite evidence-based guidance on the management of upper gastrointestinal bleeding (UGIB), variability between hospitals and local protocols exist [3]. We sought to evaluate the average time from admission to endoscopy for those presenting with an UGIB at an Irish tertiary endoscopy centre, Mater Misericordiae University Hospital (MMUH) over a 9 year period (2015-2023) and to investigate the factors influencing the time to endoscopy.

Methods The MMUH Hospital Inpatient Enquiry (HIPE) database was interrogated for patients with a discharge diagnosis pertaining to UGIB and this was cross-referenced with the inpatient endoscopy database (EndoRAAD). Between-group comparisons were made with the unpaired t-test and linear regression.

Results From 2015-2023, 1016 UGIBs were identified. 403 (40.1%) were female and the average age was 64 years (SD=17.8). 16 UGIB presentations requiring emergency endoscopy were identified. The median time to endoscopy was 1.91 days. 678 patients (67%) had endoscopy within two days of admission. On average, the time spent in the emergency department resulted in a 14 hour delay to endoscopy. The number of OGDs for UGIB was increasing by 9% per year (R²=0.34) and there was no difference between genders on time to endoscopy(p=0.07). Regression analysis showed that increasing age (p=0.02)(R²=0.006) but neither gender(p=0.14), GBS Score(p=0.73) nor the presence of varices (p=0.25) influenced time to endoscopy. Patients admitted on Friday(p<0.001) or Saturday(p=0.02) had a longer time to endoscopy compared to other days of the week whilst those admitted between Friday and Sunday had a longer wait time to endoscopy than those admitted between Monday and Thursday (2.73±1.3 days compared to 1.3±1.2 days, p<0.001).

Conclusions The MMUH endoscopy service is performing well but not entirely adherent to current ESGE guidelines when evaluating those with upper gastrointestinal bleeding. The rising number of presentations with UGIB necessitates a commitment to continue to resource endoscopy at MMUH to reach ESGE standards. The day of presentation was a significant factor in determining time to endoscopy. The delay resulting from wait times in the emergency department suggests the development of an UGIB pathway to expedite endoscopy for patients presenting in the emergency department would be beneficial.

Publication History

Article published online:
27 March 2025

• References

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