Improving triage in upper gastrointestinal bleeding: insights from the UK National Endoscopy Database (NED)

Abstract

Background and aims We aimed to analyse data from the UK National Endoscopy Database (NED) to investigate factors associated with endotherapy in patients with suspected upper gastrointestinal bleeding (UGIB) . Methods Analysis of oesophagogastroduodenoscopy (OGD) uploads to the NED from 1 March 2019 to 29 February 2020 was performed. UGIB was defined as procedures with indications of melaena and/or haematemesis. The proportion where endotherapy was performed was calculated. Mixed-effects logistic regression was performed with patient sex, patient age, type of admission (inpatient, outpatient, unclassified) and symptoms as fixed effects on the dependent variable (receipt of endotherapy). Results were presented as adjusted ORs (aORs) with 95% CIs. Results 47 481 OGDs were performed for UGIB; endotherapy was performed in 14.8%, increasing to 20.0% when only inpatient OGDs were analysed. Patients aged 18–39 years were half as likely to undergo endotherapy than those aged 50–59 years (aOR 0.5, 95% CI 0.5 to 0.6), with male patients at higher risk than females (aOR 1.3, 95% CI 1.2 to 1.4). Patients with both melaena and haematemesis were nearly three times more likely to receive endotherapy (aOR 2.8, 95% CI 2.6 to 3.0) compared with those with melaena alone. Conversely, patients with only haematemesis had a lower risk than those with melaena alone (aOR 0.9, 95% CI 0.8 to 0.9). Conclusions Younger and female patients were at lower risk of undergoing endotherapy, while patients with both melaena and haematemesis were at three times the risk as those with each symptom alone. Incorporating these findings into UGIB risk scores could improve patient triage. Data are available on reasonable request.