A retrospective and prospective study on the safety of discharging selected patients with duodenal ulcer bleeding on the same day as endoscopy☆,☆☆,★
Section snippets
Retrospective analysis
A retrospective analysis was carried out on all patients that had undergone endoscopy over an 18-month period between January 1991 and June 1992. The hospital inpatient and endoscopy records of all the patients with a history of hematemesis and/or melena and endoscopic findings of peptic ulcer were reviewed. A subgroup analysis was performed in those who were judged to have low rebleeding risk defined as follows: (1) age less than or equal to 60 years; (2) hemoglobin level above 9.0 gm/dL on
Retrospective study
Over the 18-month period, 459 patients presented with upper gastrointestinal bleeding. Of these, 284 patients had peptic ulcers and 72 patients satisfied the inclusion criteria for early discharge. The characteristics of the patients are shown in Table 1.
Seventy-two patients were discharged at the discretion of the responsible physician, depending on concomitant medical illnesses and the condition of the patients. Only two thirds (65.3%) of patients were discharged on the day of endoscopy. The
DISCUSSION
Clinical and endoscopic parameters are highly predictive of recurrent hemorrhage.2, 8, 9, 10, 11, 12, 13, 14 It has been proposed that patients with clean-based ulcers can be discharged soon after volume resuscitation, stabilization, and institution of anti-ulcer therapy.1 One recent study assessed the outcome of outpatient care after emergency endoscopy in this category of patients with gastrointestinal bleeding and documented the low rate of rebleeding and lack of need for emergency surgery.
References (22)
- et al.
Controlled trial of endoscopic sclerosis in bleeding peptic ulcers
Lancet
(1987) - et al.
Randomized comparison of Nd YAG laser, heater probe, and no endoscopic therapy for bleeding peptic ulcers
Gastroenterology
(1990) - et al.
The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors
Gastrointest Endosc
(1981) Etiology and prevalence of severe persistent upper gastrointestinal bleeding
Gastroenterology
(1983)- et al.
Prospective evaluation of immediate versus delayed refeeding and prognostic value of endoscopic findings in patients with upper gastrointestinal hemorrhage
Gastroenterology
(1992) - et al.
Outpatient care of selected patients with acute non-variceal upper gastrointestinal haemorrhage
Lancet
(1995) Rolling review: upper gastrointestinal bleeding
Aliment Pharmacol Ther
(1993)Therapeutic endoscopy and bleeding ulcers
JAMA
(1989)- et al.
Incidence and mortality of acute upper gastrointestinal haemorrhage in the United Kingdom
BMJ
(1995) Multipolar electrocoagulation in the treatment of active upper gastrointestinal hemorrhage: a prospective controlled trial
N Engl J Med
(1987)
Heat probe for hemostasis of bleeding peptic ulcers: techniques and results of randomized controlled trial
Gastrointest Endosc
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2008, Clinical Gastroenterology and HepatologyCitation Excerpt :Low-risk patients included patients with pigmented dots or clean base ulcers.7,19 Among the latter, a subgroup of very low-risk patients were identified when they also met a set of published clinical criteria1,20–23 that allowed discharge after endoscopy (with an empirical attribution of LOS of 1 day). The base-case scenario used estimated proportions from a Cochrane review11 (which included preliminary data from Lau et al presented in abstract form), whereas an alternate scenario adopted assumptions on the basis of the recent full publication by Lau et al10 with regard to the proportions of patients with different endoscopic appearances in both pre- and post-endoscopy PPI patient groups.
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From the Division of Gastroenterology, Department of Medicine, University of Hong Kong, Hong Kong.
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Reprint requests: Dr. Kam-Chuen Lai, Gastroenterology, Rm 301, New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong.
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