To determine whether the timing of therapeutic endoscopic injection affects prognosis in major peptic ulcer bleeding.Design:
Single operator, prospective study of high-risk patients treated by injection therapy, during routine working hours or out of hours. Outcome was further related to the timing of endoscopy.Setting:
Four acute admitting units in the Lothian region, UK: Edinburgh Royal Infirmary, Western General Hospital, Eastern General Hospital and St John's Hospital, Livingston.Patients:
The study included 114 patients undergoing attempted emergency endoscopic injection treatment for bleeding peptic ulcer between November 1991 and September 1992.Results:
Fifty-eight patients underwent endoscopy during working hours, while 56 were endoscoped out of hours. Initial complete examination was possible in 45 patients treated during working hours and 45 treated out of hours, although successful panendoscopy was eventually performed in all. Injection therapy was given to 53 patients during working hours and 54 patients out of working hours. The outcome of both groups was very similar in terms of need for emergency surgery, rebleeding, mean transfusion requirements and mortality. Thirty-seven patients underwent endoscopy within 6h of admission, 39 were endoscoped between 6 and 12 h and 38 were examined between 12 to 24 h. Risk factors, initial endoscopic completeness, findings and injection were equally distributed between each time period. Outcome in terms of emergency surgery, rebleeding, transfusion and death was very similar in each group.Conclusions:
Although the prognosis of patients presenting with peptic ulcer haemorrhage is improved by endoscopic intervention, very early out of hours endoscopy does not improve prognosis. Although there will inevitably occasionally be very ill patients who will require urgent out of hours endoscopic therapy, most patients who present with bleeding peptic ulcer can be safely managed on the next available list.