Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2005; 11(45): 7122-7130
Published online Dec 7, 2005. doi: 10.3748/wjg.v11.i45.7122
Outcome of non-variceal acute upper gastrointestinal bleeding in relation to the time of endoscopy and the experience of the endoscopist: A two-year survey
Fabrizio Parente, Andrea Anderloni, Stefano Bargiggia, Venerina Imbesi, Emilio Trabucchi, Cinzia Baratti, Silvano Gallus, Gabriele Bianchi Porro
Fabrizio Parente, Gastroenterology Unit, A. Manzoni Hospital, Lecco, Italy
Andrea Anderloni, Gastrointestinal Unit, Ospedale Maggiore della Carità, Novara, Italy
Stefano Bargiggia, Venerina Imbesi, Gabriele Bianchi Porro, Academic Department of Gastroenterology, L. Sacco University Hospital, Milan, Italy
Emilio Trabucchi, Cinzia Baratti, Department of Accident and Emergency and Postgraduate School of General Surgery, L. Sacco University Hospital, Milan, Italy
Silvano Gallus, Mario Negri Pharmacological Institute, Section of Medical Epidemiology, Milan, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr Fabrizio Parente, Gastroenterology Unit, A. Manzoni Hospital, Via dell’Eremo 9-11, 23900 Lecco, Italy. fabrizio.
Telephone: Fax: +39-0341-489966
Received: March 25, 2005
Revised: May 8, 2005
Accepted: May 12, 2005
Published online: December 7, 2005

AIM: To prospectively assess the impact of time of endoscopy and endoscopist’s experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.

METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.

RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience. Univariate analysis showed that higher endoscopist’s experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy. On multivariate analysis, endoscopist’s experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for rebleeding and 6.90 for need of transfusion after the endoscopy.

CONCLUSION: Endoscopist’s experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis.

Keywords: Non-variceal acute GI bleeding, Time of endoscopy, Surgeon’s experience, Endoscopic hemostasis