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Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study
David J Bjorkman1, Atif Zaman, M Brian Fennerty
1Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah 84132-2101, USA.
Gastrointestinal Endoscopy
|July 2, 2004
Summary
Urgent endoscopy for acute upper-GI bleeding did not reduce hospital stays or resource use. Physician decisions, not early endoscopy results, determined patient admission, highlighting the need for results to influence care.
Area of Science:
- Gastroenterology
- Health Services Research
Background:
- Acute upper-GI bleeding management often involves endoscopy.
- Urgent endoscopy may identify patients suitable for outpatient care, potentially reducing hospital resource utilization.
Purpose of the Study:
- To evaluate if urgent endoscopy decreases healthcare resource utilization in acute upper-GI bleeding.
- To assess the impact of urgent endoscopy on patient outcomes in a real-world setting.
Main Methods:
- A multicenter trial randomized 93 outpatients with acute upper-GI bleeding.
- Patients were assigned to either urgent (pre-hospitalization) or elective (post-admission) endoscopy.
- Medical outcomes and resource utilization were compared between groups.
Main Results:
- Endoscopy timing did not significantly impact resource utilization or patient outcomes.
- Length of hospital stay and intensive care unit (ICU) days were similar between urgent and elective endoscopy groups.
- Despite recommendations for outpatient care in 40% of urgent cases, only 4 patients were discharged, and high-risk lesions were more frequent in the urgent group.
Conclusions:
- Urgent endoscopy did not reduce hospitalizations or resource utilization.
- The impact of early endoscopy on resource utilization is contingent on its results influencing physician decisions regarding patient admission.
- To improve efficiency, early endoscopy findings must actively alter subsequent patient management and disposition.