Authors (including presenting author) :
Kai YM (1), Wong IW (1), So CK (2), Fung SC (1), Got ML (3), Wong YH (3), Lam CT (2), Lee KH (1), Chow TL (2), Chan YC (1)
Affiliation :
(1) Accident & Emergency Department, United Christian Hospital, (2) Department of Surgery, United Christian Hospital, (3) Endoscopy Centre, United Christian Hospital
Introduction :
Majority of patients presenting with symptoms and signs of acute UGIB are admitted to surgical wards for monitoring and treatment in daily practice. A pilot program was conducted in the emergency medicine ward in collaboration with Department of Surgery ,and Endoscopy Centre of United Christian Hospital in which selected patients with acute UGIB were admitted for early OGD in order to relieve the burden of surgical wards.
Objectives :
1. To safely and effectively manage patients with mild UGIB in emergency medicine ward in collaboration with surgery colleagues.
2. To reduce admission to surgical wards and facilitate early discharge and timely follow up of patients with mild UGIB.
Methodology :
Patients aged 50 or above with acute self-limiting UGIB (e.g. coffee ground vomitus, mild hematemesis after repeated vomiting, melena / tarry stool) and not living in old-aged home were included in the program. Those with haemodynamic instability, haemoglobin level ≤ 10 g/dL, lNR≧1.5, platelet count < 50 x 109/L, evidence of acute abdomen, history of cirrhosis and anticoagulants / antiplatelets (except aspirin) usage were excluded. Upon admission, baseline blood tests and X-rays were taken. Patients were fasted and given intravenous pantoprazole 40mg Q12H. OGD was arranged preferably in the next day. After procedure patients were transferred back to emergency medicine ward for monitoring and, if needed, admitted to surgical ward for further management. Patients would be called back for appropriate follow up and treatment if OGD biopsy showed presence of Helicobacter pylori, intestinal metaplasia or malignancy.
Result & Outcome :
A total of 29 patients (17 male, 12 female) were admitted to emergency medicine ward from October 2020 to November 2022 with an average age of 65.3. The average length of stay was 1.79 days and 93.1% of OGD were done within 1 day after admission.
44.8% of patients were diagnosed to have gastritis / duodenitis, 41.4% to have gastric ulcer / duodenal ulcer and 6.9% to have suspected cancer. Among the cases with gastric ulcer / duodenal ulcer, 4 had active haemorrhage and were controlled with adrenaline injection, heated probe or clipping. The average haemoglobin drop after OGD was 0.824 g/dL with no mortality case. Concerning biopsy results, 6 cases showed presence of Helicobacter pylori and were given eradication therapy. 3 cases were confirmed to have carcinoma and 2 cases were shown having intestinal metaplasia. All received timely and suitable follow up.
62.1% of patients were discharged home with the remaining admitted to surgical wards for further monitoring or re-scope (except 1 case which was admitted to medical ward for suspected neurological problem). After discharge for acute UGIB episode, 93.1% of patients were being followed up by surgeons with an average specialist out-patient clinic appointment time of 16.8 weeks. 6 cases (20.7%) were arranged to have re-scope after discharge and the average re-scope time was 7.5 weeks. 2 cases were discharged without follow up arranged. 1 patient re-attended 1 day after discharge from emergency medicine ward for tarry stool. Blood tests showed stable haemoglobin level and patient was discharged with follow up as planned.
