PhD Scientific Days 2024

Budapest, 9-10 July 2024

Theoretical and Translational Medicine III.

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

Author(s)

Mahmoud Obeidat1,2, Diana-Elena Floria1,3, Brigitta Teutsch1,4, Stig Laursen5, Marine Camus6, Franck Verdonk7, Áron Vincze8, Zsolt Bognár9, Vasile Drug3, Keith Siau10, Ian Gralnek11, Péter Hegyi1,2,12, Bálint Erőss1,2,12
1: Centre for Translational Medicine, Semmelweis University, Budapest 1085, Hungary
2: Institute of Pancreatic Diseases, Semmelweis University, Budapest 1083, Hungary
3: Grigore T. Popa University of Medicine and Pharmacy, Iași 700115, Romania
4: Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
5: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
6: Sorbonne University, Endoscopic Unit, Saint Antoine Hospital Assistance Publique Hopitaux de Paris, Paris, France
7: Sorbonne University, Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
8: Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
9: Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
10: Royal Cornwall Hospitals NHS Trust, Department of Gastroenterology, Truro, United Kingdom
11: Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
12: Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7623, Hungary

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.