Emergency upper gastrointestinal bleeding. Management and outcomes in specialty private practice

Severe upper gastrointestinal (UGI) bleeding is a common medical emergency associated with significant morbidity and mortality. Recent studies from selected academic medical centers show that emergency UGI endoscopy with therapeutic intervention prevents recurrent hemorrhage, reduces complications, and limits costs. We determined prospective outcomes for patients presenting to 11 hospitals in Minneapolis and treated by 17 gastroenterologists from an independent single-specialty group. All 291 patients with severe UGI bleeding seen from July 1994 to January 1995 were enrolled and treated according to a guideline that the gastroenterologists had previously agreed upon. Chart review after hospital discharge showed that therapeutic endoscopy resulted in substantial reductions in the risk of recurrent bleeding compared with recent historic controls; the reductions were comparable to those seen in randomized studies from academic centers. Low risk of recurrent bleeding was associated with fewer blood transfusions and fewer days in hospital and in ICU. We conclude that 1) committed specialists can develop and adhere to treatment plans that optimize patient benefit and limit costs, and 2) therapeutic endoscopy performed by gastroenterologists in community hospitals may be as effective as endoscopy performed by academicians with a special interest in UGI bleeding.