Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial.
BACKGROUND
Patients with acute nonvariceal upper GI hemorrhage are routinely hospitalized, regardless of clinical status or endoscopic findings. The aim of this study was to compare outcomes for outpatient versus hospital care of patients with nonvariceal upper GI hemorrhage at low risk of recurrent bleeding.


METHODS
Endoscopic and clinical criteria were used to select patients at low risk for recurrent bleeding. Ninety-five consecutive patients were randomized for either early discharge and outpatient care (48) or hospital care (47). Baseline clinical and endoscopic features were comparable. During the first 30 days patients were examined daily by their primary care physician and contacted by a gastroenterologist by telephone to assess clinical status. Rates of recurrent bleeding, hospitalization, surgery, and mortality were determined.


RESULTS
All patients underwent endoscopy within 12 hours of the onset of hemorrhage. No patient underwent surgery or died. Rates of recurrent bleeding were 2.1% in the early discharge group and 2.2% in the hospital-treated group (1 patient in each group). Median costs were $340 for the outpatient group and $3940 for the hospital group (p = 0.001).


CONCLUSIONS
Outpatient care of patients at low risk for recurrent nonvariceal upper GI hemorrhage is safe and can lead to significant savings in hospital costs.
Cipolletta
Livio
L
Department of Gastroenterology and Digestive Endoscopy, Regione Campania and the Ospedale Maresca, Torre del Greco, Italy.
Bianco
Maria Antonia
MA
Rotondano
Gianluca
G
Marmo
Riccardo
R
Piscopo
Roberto
R
D000208:Acute Disease; D000553:Ambulatory Care / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000191:economics / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors