PhD Scientific Days 2024

Theoretical and Translational Medicine III.

Pre-endoscopic Assessment and Management in Patients with Acute Upper Gastrointestinal Bleeding: An International Survey of 533 Clinicians

Text of the abstract

INTRODUCTION
Upper gastrointestinal bleeding (UGIB) continues to pose a significant threat to patients presenting at the emergency department, especially if the patients present with hemodynamic instability (HI). There are still some uncertainties in the guidelines about the pre-endoscopic stepwise assessment for those patients.

AIMS
To report practice patterns to better understand the pre-endoscopic assessment.

METHODS
This is a prospective international online survey. The distribution was conducted from April 2023 to November 2023. The target population was active physicians with clinical practices focusing on the management of patients with UGIB. The survey included four main sections with 33 questions. It was endorsed by several national and international gastroenterology societies. The primary analysis was a descriptive proportional assessment of individual survey response items.

RESULTS
In total, 533 clinicians completed our survey from 50 countries. Over half of the respondents work at university-based hospitals (54.6%) and have over 100 UGIB patients hospitalized annually (67.7%). In 29.1% of the hospitals, there was no specific protocol or guideline for the initial assessment of patients with suspected UGIB. In 44.7%, there were no emergency on-call interventional radiology services. Among the respondents, 39.6% do not use any risk stratification scores at the time of patient presentation. In 40.7% of the answers, clinicians do not use any major hemorrhagic protocol for patients with severe ongoing bleeding. Prokinetics were generally little or never used prior to endoscopy (34.3%). The most chosen optimal time for endoscopy was within 24 hours for stable patients with non-variceal bleeding and within 12 hours for variceal bleeding. If patients were unstable but responding to resuscitation, the most chosen time was within 6 hours regardless of the source of bleeding and within 2 hours for those with persistent HI.

CONCLUSION
Adherence to international gastroenterology guidelines is low. There is a significant variability in different assessment approaches among respondents. Based on our data, the optimal time for endoscopy seems to be dependent on the hemodynamic status in both variceal and non-variceal bleeding. Our study highlights opportunities for improving consistency in reporting data and identifies potential areas for research.