Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: An effectiveness study

David J. Bjorkman, Atif Zaman, M (Brian) Fennerty, David Lieberman, James A. DiSario, Ginger Guest-Warnick

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Background Urgent endoscopy in patients with acute upper-GI bleeding identifies many patients who may be safely treated without hospitalization. The aim of this multicenter trial was to determine whether urgent endoscopy effectively decreases health care resource utilization in a real-life setting where primary care providers determine the course of care. Methods Ninety-three outpatients with acute upper-GI bleeding were randomized to either urgent endoscopy (before hospitalization) or elective endoscopy after admission. The results of urgent endoscopy and a recommendation regarding patient disposition were provided to the attending physician. Medical outcomes and resource utilization were measured. Results The timing of endoscopy did not affect resource utilization or patient outcomes. Length of stay was similar (urgent endoscopy, OR 3.98 days: 95% CI[2.84, 5.11] vs. elective endoscopy, OR 3.26 days: 95% CI[2.32, 4.21], p=0.45). The mean number of days in an intensive care unit was the same (1.2 days). The urgent endoscopy group had more high-risk endoscopic lesions (15 vs. 9; p=0.031). Outpatient care was recommended for 19 patients (40%). Only 4 patients were discharged. Conclusions Urgent endoscopy did not reduce hospitalization or resource utilization because the results of early endoscopy did not impact the decision by attending physicians regarding admission. For early (triage) endoscopy to impact resource utilization, the results of endoscopy must change subsequent patient care.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalGastrointestinal Endoscopy
Volume60
Issue number1
DOIs
StatePublished - Jul 2004
Externally publishedYes

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Endoscopy
Hemorrhage
Hospitalization
Patient Acceptance of Health Care
Physicians
Triage
Health Resources
Ambulatory Care
Multicenter Studies
Intensive Care Units
Length of Stay
Primary Health Care
Patient Care
Outpatients

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding : An effectiveness study. / Bjorkman, David J.; Zaman, Atif; Fennerty, M (Brian); Lieberman, David; DiSario, James A.; Guest-Warnick, Ginger.

In: Gastrointestinal Endoscopy, Vol. 60, No. 1, 07.2004, p. 1-8.

Research output: Contribution to journalArticle

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