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Upper gastrointestinal endoscopy at four intensive care units in one hospital: frequency and indication
P W Plaisier1, H R van Buuren, H A Bruining
1Department of General Surgery, University Hospital Dijkzigt of the Erasmus University Rotterdam, The Netherlands.
Objective:
To investigate the frequency, indication and results of upper gastrointestinal endoscopy (UGIE) at four different intensive care units (ICUs) in one hospital.
Design:
Retrospective analysis.
Setting:
Rotterdam Erasmus University Hospital, The Netherlands.
Participants:
One hundred and ninety-nine male and 102 female patients; mean age, 58.3 years (range, 14-91 years).
Interventions:
Four hundred and eleven UGIEs.
Main Outcome Measures And Results:
UGIE was primarily diagnostic and therapeutic in 55% and 45% of patients, respectively. Seventy-three per cent of the diagnostic UGIEs were performed for localization of a haemorrhage and 70% of the therapeutic UGIEs for placement of feeding tubes. The causes of haemorrhage were varices, duodenal ulcer and oesophagitis in 26, 22 and 14% of cases, respectively. As co-incidental findings, oesophagitis, gastritis and gastric ulcer were seen in, respectively, 18, 8 and 7% of cases. The vast majority of UGIEs (81%) were performed at the surgical and medical ICUs. At the medical ICU, upper gastrointestinal haemorrhage (UGIH) usually was the ICU admission diagnosis, and usually concerned varices (56%). At the surgical ICU, UGIH was usually not the ICU admission diagnosis but a postoperative complication, and usually concerned oesophagitis (25%) or a duodenal or gastric ulcer (25 and 13%, respectively). Of all ICU patients, surgical patients were most prone to have co-incidental abnormalities of the digestive tract at UGIE (63%).
Conclusions:
UGIE is a frequent diagnostic and therapeutic procedure in patients admitted to the ICU, particularly at the surgical and medical ICU. Diagnostic and therapeutic endoscopy are most frequently performed for assessment of bleeding and placement of feeding tubes, respectively. Oesophagitis is a surprisingly common finding, both as a co-incidental diagnosis as well as the cause of bleeding, especially after surgery.