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DOI: 10.1055/s-0038-1637474
24/7 ENDOSCOPY: IS IT NECESSARY?
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Nonvariceal Upper GI bleeding (UGIB) is frequent condition in a daily clinical practice. One of the leading positions in hemostasis belongs to endoscopic procedures with wide spectrums of hemostatic facilities available. Aim was to analyze hospital's experience to understand if emergency endoscopy is needed in clinic that doesn't accept acute patients with GI bleeding, but have 1168 beds in 56 departments including 5 intensive care units (ICU).
Methods:
Emergent endoscopy procedures were performed in 59 patients between January 2016 and October 2017, mean age 58,2 years (28 – 86), 39 male. All patients had severe conditions with multiple organ failure, renal failure, combined trauma or were from ICU, bleeding accured during hospital stay. Sources of UGIB, rebleeding rate and outcomes are presented in table.
|
Esophageal lesions |
Gastric ulcer, Dieulafoy's lesions |
Gastric, duodenal erosions, angioectasias and tumors |
Duodenal ulcer |
Post endoscopic procedures |
|
|
Amount |
9 |
22 |
10 |
14 |
4 |
|
Rebleeding, n (%) |
3 (33,3) |
9 (40,9) |
2 (20) |
3 (21,4) |
3 (75) |
|
Surgery, n (%) |
5 (22,7) |
2 (20) |
1 (25) |
||
|
Death |
1 |
3 |
Results:
Type of hemostasis was chosen by endoscopist individually, including combined methods, PPI was prescribed. Epinephrine was not used as monotherapy. In bleeding from esophageal lesions polysaccharide was the most effective, in gastric ulcers as in Dieulafoy's lesions – both clipping and APC, in tumors all the methods were used. In duodenal ulcers mostly APC was used because of the ulcers location. Primary hemostasis was effective in 66,1% of patients, 33,9% needed further endoscopic interventions or were operated. High level of reinterventions and mortality is associated with severe coexisting conditions, that bring patients to the high-risk group of complications.
Conclusions:
Bleeding may have strong influence on outcome and worse patient's condition quickly. In a high-volume multidisciplinary hospital skilled endoscopist should be available 24/7, with the wide range of hemostatic facilities.