P41 Current management of upper GI bleeding in a tertiary centre

• Published in: Gut Vol. 73; no. Suppl 1; pp. A73 - A74
• Main Authors: Jeong, Youjin, Morrison, Maura, Spiers, Jessica, Harrow, Paul
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.06.2024; BMJ Publishing Group LTD
• Subjects: Antiplatelet therapy; Bleeding; Electronic health records; Electronic medical records; Endoscopy; Gastroenterology; Gastroscopy; Hemoglobin; Malignancy; Patients; Peptic ulcers; Platelets; Poster Presentations
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2024-BSG.123

IntroductionAcute upper gastrointestinal bleeding is a common medical emergency associated with significant mortality. NICE guidance highlights key quality measures.1 This study reports outcomes from a large tertiary centre and examines how the use of the BSG acute upper GI bleeding bundle2 could lead to improvements in compliance.MethodsA search of the electronic health record (EPIC) was completed to include all patients undergoing gastroscopy with the indication: suspected upper GI bleeding between April and October 2023. Patients were excluded if the investigation was performed as an outpatient. Outcome data were extracted retrospectively from the electronic health record.Results59 patients underwent emergency endoscopy in the study period (62.8% male, median age 66 years). 35/59 (59.3%) patients were risk stratified with a documented Blatchford score and 4 (5.1%) patients had a Rockall score recorded. 29 patients (49.1%) received red cell transfusion (all with a target haemoglobin of 70–90), 4 (6.8%) received platelet transfusion (all with a target platelet count of 50), 5 (6.8%) received FFP, 1 (1.7%) received cryoprecipitate, and 2 (3.4%) received PCC.Only 32/59 patients (54.2%) underwent an OGD within 24 hours of first presentation with bleeding predominantly limited by endoscopy or theatre capacity.. 23 patients (22%) had peptic ulceration, 5 patients (6.8%) had varices of any grade, 1 patient (1.7%) had an upper GI malignancy. 9/23 with peptic ulcers required endotherapy (9/9) and were treated with dual therapy (clips and adrenaline). 2 (3.4%) patients underwent variceal banding, and 1 (1.7%) patient was treated with haemostatic powder.Among those on antiplatelet or anticoagulation therapy, 10 patients (66.7%) restarted antiplatelet therapy and 9 patients (60%) restarted anticoagulation prior to discharge from hospital.ConclusionsThere is incomplete adherence to existing NICE guidance in the management of GI bleeding which reflects limitations in current training, the wide range of teams involved and service provision. Early involvement of gastroenterology and the addition of the BSG acute upper GI bleeding bundle to local training may help to improve guideline adherence.ReferencesAcute upper gastrointestinal bleeding in over 16s: management NICE guideline CG141 2012.Siau K, Hearnshaw S, Stanley AJ, et al. British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding. Frontline Gastroenterol. 2020;11(4):311–323. Published 2020 Mar 27. doi:10.1136/flgastro-2019–101395.