Time to endoscopy (flexible camera) for bleeding within the digestive tract

What is it about?

Internal bleeding / haemorrhage from the upper digestive system (oesophagus, stomach and small bowel) is a common medical emergency, for which endoscopy is the mainstay of treatment. Endoscopy involves the passage of a flexible camera to directly visualise and treat the bleeding at source, without requiring an operation. Examples of quality have been provided by national guidelines; the majority of which recommend endoscopy within 24 hours of admission to hospital. We aimed to study whether these standards were met in 20 hospitals within the Midlands, UK, and whether there were factors associated with not meeting this target. Finally, we explored whether endoscopy within 24 hours affected patient outcomes of rebleeding, length of hospital stay and mortality, compared to patients who did not.

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Why is it important?

1) This was the first large scale audit of this topic to be designed and conducted by trainee doctors 2) This study shows that the time to endoscopy can vary significantly according to the admission hospital within the Midlands, with some centres showing better performance than others 3) Early referral for endoscopy is key to getting endoscopy on time 4) Patients who receive endoscopy earlier generally had more severe bleeding. Despite this, early endoscopy was also associated with shorter stay in hospital. 5) Better teamwork between frontline departments (emergency departments and acute medical units) and specialist endoscopy units are required for timely endoscopy

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