Journal meeting

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Journal meeting

• Outpatient management of Upper Digestive
  Hemorrhage Not associated With portal Hypertension

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• OBJECTIVES
• Evaluate the safety of outpatient management of
  upper GI hemorrhage not associated with portal
  hypertension
• 80-85 UGIH episodes not associated with portal
  hypertension

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• METHODS
• 1.prospective cohort
• 2.983 subjects(1994-1997)
• Initial diagnosis of UGIH
• 1.hematemesis or melena during the 7 days before
  arrival on ED
• 2.or after rectal examination or enema
• 3.or hematic content after placement with NG tube
  or with endoscopy

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• Examination Protocol
• 1.Determination of hemodynamic status
• 2.detailed anamnesis with age, sex, form of
  presentation of UGIH(hematemesis, melena, or
  both), onset, and evolution, hx of smokingetc.
• 3.Immediate PE
• 4.Laboratory tests
• 5.Gastroscopy

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• Admission criteria
• 1.severe or massive hemodynamic repercussion
• 2.active bleeding stigmata, visible vessel, or
  adhered coagulum in endoscopy
• 3.impossibility of performing endoscopy
• 4.severe heart failure, MI, CVA,
  coagulopathy.etc.

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• 1.total 983 patients
• Hospitalized group(HG)767(78)387 due to poor
  associated condition
• Outpatient group(OG)216(22), 15 lost of F/U

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• Return to ED criteria
• Melenagt3 days
• Increase in frequency or intensity of melena
• Hematic, vomiting, lightheadedness or fainting

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• Outcome
• Rebleeding in 10 days
• The need of emergency surgery during the
  subsequent 15 days

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• Results (poor outcomes)
• Recurred hemorrhageHG-56(7.3)V.S.OG-1(0.5)
• Emergency surgeryHG-43(5.6)V.S.OG-1(0.5)
• MortalityHG-20(2.6)V.S.OG-3(1.5)
• 1.in HG 12 pts were related to UGIH
• 2.in OG 1 pr was related to UGIH

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• Factors--- rebleeding or emergency surgery
• 1.Antecedents of upper gastrointestinal surgery
• 2.Hemodynamic repercussion
• 3.Cause of hemorrhage( neoplastic or not)
• 4.Endoscopic stigmata of recent bleeding

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• Results
• Indicate outpatient F/U of a subgroup with UGIH
  was safe and not associated with increased risk
  of advise outcomes
• The only mortality related to UGIH in OG was
  aorthoenteric fistula
• Endoscopic stigmata can disappear with time(53.2h
  V.S. 36.2h)

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• Limitations
• 1.not assigned randomly
• 2.loss of 15 outpatients F/U in the OG group
• 3.generalization of results the use of
  subjective criteria of the attending GI doctors
  to decide whether the patient hospitalized or
  receive outpatient treatments