Acute variceal bleeding and out-of-hours endoscopy: Evaluation of an emergency care setting according to Baveno VI guidelines adherence. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Alves da Silva, Joana; Falcão, Daniela; Maia, Luís; Guedes, Tiago Pereira; Garrido, Mónica; Novo, Maria Inês; Rocha, Marta; Pinto, Pedro; Moreira, Teresa; Ferreira, José Manuel; Pedroto, Isabel
• Is Part Of: Digestive and liver disease. Volume 53:Issue 10(2021)
• Page Start: 1320
• Page End: 1326
• Publication Date: 2021-10
• Subjects: Emergency medical services -- Gastrointestinal hemorrhage -- Guideline adherence -- Liver cirrhosis -- Portal hypertension; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2021.07.004
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: The extent to which patients with acute variceal bleeding (AVB) receive recommended care is largely unknown. Aim: to evaluate the adherence of the 4 major Baveno VI recommendations [vasoactive agents, prophylactic antibiotic, esophagogastroduodenoscopy (EGD) within 12 hours, endoscopic variceal ligation (EVL)] as a marker of quality of an emergency model. Methods: Retrospective evaluation of AVB admissions to a tertiary centre in which endoscopy was available 24hours-a-day, with a regional out-of-hours service at night (the furthest hospital is 200Km away). Patients were divided in directly admitted or transferred from other centres. Results: 210 AVB patients were included; 101 (48.1%) were directly admitted. The majority of patients were submitted to vasoactive agents (85.7%) and prophylactic antibiotics (79%) before EGD. In 178 patients (84.8%) endoscopy was performed within 12h and EVL was the procedure of choice in 116 (74.8%) (only oesophageal varices). No significant differences were observed between directly admitted and transferred patients in adherence rates. Overall rebleeding rate was 8.6%, in-hospital mortality 11.4% and 6-week mortality 20%. Conclusion: Adherence to quality metrics was high which might have played a vital role for reported outcomes. These results suggest that this model of care, provides accessibility and equity in access to urgent endoscopy.