Insights into Endoscopic Management and outcomes for Acute Upper Gastrointestinal Bleeding: A Prospective Multicentre UK audit of 5000 patients
Bibliographic record
Abstract
Aims Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. We present the findings on endoscopic management of AUGIB patients in the UK. Methods A prospective multicentre audit included adults (>16 years) in 152 UK hospitals with AUGIB between May 3 and July 2, 2022. Results In this study of 5101 cases,83%(4228) underwent endoscopy for AUGIB, with median age of 69 yrs & in-patient mortality of 7.7% (328/4228). Glasgow-Blatchford score(GBS), stratified patients into 4% low-risk(GBS 0-1), 21% medium-risk(2-6),36% higher-risk(7-11),& 26% very high-risk(≥12).32% were on anticoagulants at presentation. Time to endoscopy from presentation: 0-6 hrs in 6%, 6-24 hrs in 33%, & 24-48 hrs in 25%. Bleeding aetiology identified at endoscopy included peptic ulceration(30%), oesophagitis(16%), varices(10% – with 90% oesophageal, 16% gastric, & 2% duodenal), portal hypertensive gastropathy(4%), malignancy(4%), & other(16%). Stigmata of recent bleeding were observed in 30%(1273) cases – 41% with blood in the upper GI tract, 5% Forrest 1a, 31% 1b, 15% 2a, 21% 2b, & 16% with high risk markings on varices. Endotherapy was applied in 27%(1135), with 54% receiving a single modality. Therapies applied included adrenaline injection (46% – with median volume of 8 mls;IQR: 5.5-10), haemostatic clip(s)(37% – with 96% endoclip(s) & 4% over the scope clip(s), variceal b&ing or injection therapy(25%), haemostatic powder/gel(19%), thermal coagulation(16%), argon plasma coagulation(11%), Sengstaken tube(2%), & Danis stent(1%). Endotherapy with only adrenaline injection &/or haemostatic powder/gel was applied in 16%. Among those receiving endotherapy, 4%(46/1135) did not achieve adequate haemostasis. 17%(199/1135 – 43% with blood in the upper GI tract, 7% Forrest 1a, 26% 1b, 18% 2a, 22% 2b, & 20% with high risk markings on varices) experienced in-patient re-bleeding, leading to repeat endoscopy in 71%, interventional radiology in 14%, & surgery in 6%.Multivariable logistic regression analyses revealed predictors for in-patient rebleeding & mortality. For rebleeding, endoscopic stigmata(OR-3.06,95% CI:2.01-4.7), very high-risk GBS scores(OR-5.49,95% CI:1.27-19.7) & presence of ulcers(OR-1.50,95% CI:1.03-2.17) were significant. Mortality was significantly associated with endoscopic stigmata(OR-2.12,95% CI:1.56-2.87), very high-risk GBS scores(OR-4.22,95% CI:1.42-12.49) & anticoagulation use(OR-1.85,95% CI:1.22-2.79). Endoscopic therapy demonstrated a trend toward decreased mortality (OR-0.45,95% CI:0.20-1.02). Time to endoscopy & various interventions were not significant in either analysis. Conclusions This prospective UK study identified an increased risk of rebleeding and mortality in very high-risk GBS patients and those with high-risk endoscopic stigmata. Endoscopic therapy showed a trend towards reducing mortality. Adherence to clinical guidelines on endoscopic management in AUGIB, endoscopists' skills training, and 24/7 access to therapeutic modalities are crucial to improve outcomes. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".