Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey

Abstract

Endoscopist's experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis.

The effect of off-hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta-analysis of 20 cohorts

“…Of these, 10 studies reported in-hospital mortality, [4][5][6]10,11,13,[15][16][17][18] nine reported 30-day mortality, 2,3,7,8,12,[19][20][21][22] and one reported both. 14 The result of meta-analysis showed that patients who were admitted during off-hours had (Table 2).…”

“…2,3,[5][6][7]14,16,18,21,22 Most recruited studies defined the ''off-hours'' as weekends only, [4][5][6][7]11,[13][14][15][16][17]21 while four studies defined it as weekends and public holidays; 3,8,12,18 one study defined it as weekends and nighttime, 20 and one study defined it as nighttime only. 19 Three studies reported results by comparison to weekend admissions as well as nighttime admissions. 2,10,22 In order to avoid repeated calculation, we combined only weekend admissions for the current analysis.…”

“…Five studies were carried out in Asia (Hong Kong, South Korea, Taiwan, and Saudi Arabia), 8,[10][11][12][13] six in North America (USA), 4,6,[14][15][16][17] and nine in Europe (Italy, the Netherlands, Serbia, and the United Kingdom). 2,3,5,7,[18][19][20][21][22] Six studies reported patients with UGIH caused by peptic ulcer, 8,10,12,19,20,22 one study included patients with bleeding gastroduodenal angiodysplasia, 17 three demonstrated the sources of bleeding were from the esophagus varix, 11,13,15 and 10 studies included patients with both variceal and nonvariceal UGIH. 2,3,[5][6][7]14,16,18,21,22 Most recruited studies defined the ''off-hours'' as weekends only, [4][5][6][7]11,[13][14]…”

“…All studies were designed as cohorts; 17 were retrospective [3][4][5][6][7][8][10][11][12][13][14][15][16][17][18]21,22 and three were prospective. 2,19,20 We contacted the authors of one of the included studies and obtained additional information for our analysis. 21 Seven studies analyzed the same administrative database (the United States National Inpatient Sample (NIS)); 4,6,[15][16][17]23,24 we finally included five with the most recent year of publication to avoid overlapping sets of patients.…”

“…Twelve studies reported surgery rate for patients with UGIH. 2,4,5,7,8,10,[12][13][14]17,19,20 Off-hours admission significantly increased the risk of surgical intervention ( Figure 3(c); OR 1.09, 95% CI 1.02-1.17, p ¼ 0.018). Subgroup analysis for studies in the USA also demonstrated that off-hours admission was associated with more surgical requirements ( Four studies reported the need for angiographic embolization for patients with UGIH; 2,6,7,10 however, the pooled effect did not show a significant correlation with off-hours admission ( Figure 3(d); OR 1.12, 95% CI 0.89-1.42, p ¼ 0.34).…”