Gastrointestinal endoscopy
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Gastrointest. Endosc. · Jul 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialUrgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study.
Urgent endoscopy in patients with acute upper-GI bleeding identifies many patients who may be safely treated without hospitalization. The aim of this multicenter trial was to determine whether urgent endoscopy effectively decreases health care resource utilization in a real-life setting where primary care providers determine the course of care. ⋯ Urgent endoscopy did not reduce hospitalization or resource utilization because the results of early endoscopy did not impact the decision by attending physicians regarding admission. For early (triage) endoscopy to impact resource utilization, the results of endoscopy must change subsequent patient care.
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Gastrointest. Endosc. · Jul 2004
Comparative StudyIncremental value of upper endoscopy for triage of patients with acute non-variceal upper-GI hemorrhage.
Risk scores for triage of patients with acute upper-GI hemorrhage that incorporate endoscopic variables (e.g., the complete Rockall Score) may have better test characteristics for identification of "low-risk" bleeding episodes than those (e.g., Blatchford Score, clinical Rockall Score) that rely solely on clinical variables. An endoscopy-based risk score was compared with two clinically based risk scores in a large cohort of patients hospitalized for treatment of acute upper-GI hemorrhage to quantify the incremental value of endoscopy in the identification of low-risk bleeding. ⋯ The complete Rockall Score identified significantly more low-risk patients with acute upper-GI hemorrhage than either the clinical Rockall Score or the Blatchford Score. Identification of additional low-risk patients via this endoscopy-based score could lead to decreases in the use of hospital-based services, iatrogenic complications, and time lost from work or usual activity, while improving quality of care. Use of the clinical and complete Rockall Scores sequentially, with consideration of outpatient care for patients at identified as low risk, is recommended.