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A NATIONAL ENDOSCOPIC DATABASE TO DETERMINE THE ADOPTION OF PHARMACOLOGICAL AND ENDOSCOPIC TECHNOLOGIES IN PATIENTS WITH NON-VARICEAL UPPER GI BLEEDING: THE RUGBE INITIATIVE
A Barkun, N Chiba, R Enns, J Marshall, D Armstrong, J Gregor, R Fedorak, and RUGBE investigators
McGill University, Health Centre, Montreal, Quebec
We used a national registry to track the adoption of new therapies such as intravenous PPI’s, and specialized endoscopic therapies across different health care settings.
METHODS: A Registry of patients presenting with acute Upper Gastrointestinal Bleeding and undergoing Endoscopy (RUGBE) was initiated 18 months ago. Data were abstracted from records at 17 institutions across Canada, and entered electronically using a common endoscopic database.
RESULTS: By April 2001, 1042 procedures (median: 55 per site) had been performed on 767 patients (37% females, mean age 66±17 years, mean: 1.4 procedures/patient). Cardiac (44%) and respiratory (22%) co-morbid conditions were frequent. Medication use included ASA (41%), NSAIDs (22%, with 39% of these on a COX2 selective inhibitor), warfarin (11%), and steroids (8%). The first endoscopy was carried out within 24 hours of the onset of symptoms in 34%. A second endoscopy was performed in 27% of patients (for follow-up or “second look” (51%), and continued or re-bleeding (31%)). Relevant endoscopic lesions were noted in the esophagus (24%), stomach (40%), and duodenum (35%) with multiple lesions noted in 6% of patients. Acid-related causes predominated (70%)(esophagitis (10%), duodenal ulcers (28%), and gastric ulcers (20%)). 32% of lesions required endoscopic therapy according to their description which was actually performed in 37% (injection (51%), thermal treatment (30%), a combination thereof (29%), ligating/clipping devices (9%)). Pharmacotherapy was given within 10.7±16.7 hrs of presentation and included a PPI in 81%. Bleeding stopped spontaneously in 56%. The mean duration of hospital stay was 6.4±7.6 days (1.1 ICU days). A mean of 2 units of blood was transfused in 52% of patients. Surgery was needed in 3%. The overall mortality was 6.1%.
CONCLUSION: These data indicate a widespread acceptance of the use of PPI’s in this patient population.