Mulholland, G.; Forrest, J.A.H.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA26
Academic Journal
Introduction and Aim: Acute upper Gl bleeding (UGIB) accounts for approximately 8% of acute medical admissions and such patients are routinely admitted for observation and diagnostic endoscopy. This study aimed to assess the safety and outcome of rapid access outpatient endoscopy for patients presenting with minor upper Gl bleeding (Rockall score zero). Study Design: Over a 3 year period patients presenting with UGIB who had a pre-endoscopy Rockall score of zero were identified in A&E.They were discharged home with an appointment for an OP endoscopy. Results: 64 patients were referred from A&E; 42 M and 21 F, mean age 37.8 (range 19-79). 42 endoscopies were performed, there being 20 DNAs and 2 inappropriate referrals (vomiting alone). 51 patients presented with haematemesis, 4 with melaena, and 7 with both. 8 patients had taken aspirin or an NSAID and 24 excess alcohol. Of the 20 DNAs 14 had misused alcohol. At endoscopy 14 patients had oesophagitis, 8 a peptic ulcer, 4 gastritis, 4 duodenitis, and 1 oesophageal varicies. 7 patients had dual pathology and 18 had a normal endoscopy. H pylori was positive in 16 of 34 patients tested. Average Hb (n = 24) was 14.3 (range 11.3-16.8). Average interval between presentation and endoscopy was 14 days (range 1-77). No patient had recurrennt bleeding. Conclusion: The study showed it to be safe practice to discharge patients from A&E with minor UGIB and a pre endoscopy Rockall score of zero and to perform an OP endoscopy. The high DNA rate (31%) reflected the significant number of patients who misused alcohol. 57% of those attending for endoscopy had significant pathology; oesophagitis being the most common abnormality. The number of A&E referrals with UGIB for OP endoscopy was significantly less than expected; probably because SHOs were unhappy to discharge such patients home.


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