HEALTH RESOURCE UTILIZATION BASED ON VARYING ENDOSCOPIC INTERVENTIONS IN UGIB WITH HIGH RISK STIGMATA: THE RUGBE INITIATIVE

A Jain¹, A Barkun¹, M Martel¹, Y Toubouti², and RUGBE Investigators

¹Division of Gastroenterology, ²Division of Clinical Epidemiology, McGill University, The McGill University Health Centre, Montreal, Quebec

Individuals with upper gastrointestinal (UGI) bleeding that reveal lesions with high risk stigmata (spurting, oozing, non-bleeding visible vessel, and adherent clot) are most often treated with injection (INJ), thermal (THERM), or a combination of these modalities. We sought to determine if any single or combined endoscopic intervention was predictive of improving health resource utilization, using length of hospital stay as a surrogate marker.
Utilizing the Canadian Registry in Upper Gastrointestinal Bleeding and Endoscopy (RUGBE), clinical and endoscopic data were extracted from medical records at 18 participating community and university sites, on individuals with high-risk stigmata; predictive models were constructed using multi-linear regression analysis.
Of the 1869 patients who entered the RUGBE registry, 691 (37%) had UGI tract lesions with high risk stigmata, of which 512 (74%) received endoscopic therapy. Seventy-six patients were excluded as they were transferred from non-RUGBE sites. 436 patients (63% male, mean age 66±16 years) with high-risk stigmata that underwent endoscopic therapy (INJ 40%, THERM 19%, INJ+THERM 36%) were analyzed. 73% were classified with an ASA Score of 3-5 (American Society of Anesthesiologists illness severity) and the mean number of co-morbidities was 2.6±1.8. Independent and significant factors that increased length of hospital stay were: advanced illness severity (ASA Score 4-5), need for blood products, and the presence of hematochezia. The use of thermal therapy alone showed a significant benefit in decreasing length of hospital stay. Injection therapy alone and combination therapy showed a trend towards improving duration of hospitalization.
This study suggests that, in individuals with high-risk endoscopic stigmata, certain endoscopic therapies decrease duration of hospitalization and are thus likely to improve health resource utilization.

The RUGBE initiative was a collaborative effort supported by the Canadian Association of Gastroenterology and an unrestricted grant by ALTANA Pharma Inc (formerly Byk Canada Inc).