Abstract
Objective: To examine the differences in rebleeding and length of hospital stay in patients with non-variceal upper gastrointestinal bleeding by time of arrival at the hospital and by number of endoscopists involved.
Patients and Methods: The subjects were 150 patients with non-variceal upper gastrointestinal bleeding who required emergency transport between 2007 and 2011 and who had undergone endoscopic hemostasis using a heater probe. They consisted of 94 patients with gastric ulcer, 30 patients with duodenal ulcer, 11 patients with Mallory-Weiss syndrome, 6 patients with anastomotic ulcer, 4 patients with gastric cancer, and 5 patients with other diseases. Hemostasis involved cauterization of the vessel until flattened for types Ia, Ib, and IIa patients in the Forrest endoscopic classification of bleeding. For type IIb patients, the clot was detached from the base of the ulcer. If a vessel was observed, it was cauterized until flattened. A second-look endoscopy was performed the next morning after treatment. Almost all patients underwent recauterization, and hemostasis was confirmed. The patients were divided into two groups by time of arrival: a group transported during a day shift (8:30-17:00) on weekdays (day-shift group) and a group transported after hours (nighttime, Sundays, and holidays) (after-hour group). A retrospective cohort study was conducted on the age of patients, Glasgow coma scale upon arrival, shock index, blood test data, Forrest endoscopic classification of bleeding, time from arrival until completion of hemostasis, blood transfusion or no transfusion, absence or presence of rebleeding, and length of hospital stay. Similarly, analysis was conducted on patients divided into two groups by number of endoscopists who examined and treated the patients: a group in which multiple endoscopists were involved (multiple-endoscopist group) and a group in which a single endoscopist was involved (single-endoscopist group).
Results: The time from arrival until completion of hemostasis was 45.4±19.1 min for the day-shift group and 70.0±34.4 min for the after-hour group, indicating a significant difference (p<0.001). The multiple-endoscopist group and single-endoscopist group showed no significant difference in the time from arrival until completion of hemostasis (p=0.058). Neither the two shift groups nor the two endoscopist groups showed any significant difference in rebleeding or length of hospital stay.
Conclusion: Even when the patients arrived at the hospital during after hours or when they were examined and treated by a single endoscopist, it was possible to minimize rebleeding and length of hospital stay by modification of hemostatic treatment.
