PTU-056 Improving re-bleed plans in patients with suspected significant upper gastrointestinal bleeding (ugib)

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Abstract

Introduction

The 2015 NCEPOD report1 found high rebleeding and mortality rates in patients with significant UGIB and recommended clearly documented rebleed plans. We audited the adequacy of rebleed plans at Nottingham University Hospitals, where 800 suspected UGIB patients are admitted annually.

Method

Patients who underwent emergency endoscopy for suspected acute UGIB between June - August 2015 were identified. We analysed patient demographics, endoscopy (OGD) findings, re-bleed plans and clinical outcomes. Focused recommendations and education were delivered to all endoscopy unit staff. Re-audit was performed during June - July 2016 and outcomes compared.

Results

130 patients: 81 (62.6%) men, median (range) age 61 (14-92); 49 (37.4%) women, median (range) age 73 (34-96) years underwent urgent OGD following suspected acute UGIB between June -August 2015. 42 (32.3%) had endoscopic evidence of active UGIB (21 (16%) variceal haemorrhage (VH), and 21 (16%) non-variceal haemorrhage (NVH)) and 88 (67.7%) had no evidence of bleeding. Only 23.1% (n=30) who underwent urgent OGD had a re-bleed plan but was higher in those with (20/42 (47.6%); 11.9% re-bled, 5% mortality) rather than without (10/88 (11.4%); 5.7% re-bled; 0% mortality) endoscopic signs of bleeding.

Results

During the 4 week re-audit period after staff engagement and education, 42 patients (66.7% men, median age 60.5; 33.3% female, median age 77 years) underwent OGD for suspected UGIB. 21.4% had endoscopic evidence of active UGIB (7.1% VH; 14.3% NVH) and 78.6% had no evidence of bleeding. Rebleed plans improved overall from 23.1% to 46.3% and were higher in those with ((77.8%); 11.1% re-bled; 0% mortality) rather than without ((37.5%); 3.1% re-bled; 0% mortality) endoscopic signs of bleeding.

Results

Most frequent re-bleed plans were repeat OGD (34.7%), CT angiogram/interventional radiology (34.7%), conservative management (16.3%) or lower GI endoscopy (6.1%). Surgery was not recommended in any initial rebleed plan.

Conclusion

Most patients with suspected acute UGIB did not have endoscopic evidence of active bleeding, but still had rebleed rates of between 3%–11%. Clear documentation of rebleed plans initially was poor, but was better in those with endoscopic signs of active bleeding. Following focused education, rebleed plans improved substantially overall from 23.1% to 46.3%, particularly in those with active bleeding from 47.6% to 77.8%, who had a higher risk of rebleeding and in-hospital mortality.

Disclosure of Interest

None Declared

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