title: Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study.
abstract: BACKGROUND
  Urgent endoscopy in patients with acute upper-GI bleeding identifies many patients who may be safely treated without hospitalization. The aim of this multicenter trial was to determine whether urgent endoscopy effectively decreases health care resource utilization in a real-life setting where primary care providers determine the course of care.
  
  
  METHODS
  Ninety-three outpatients with acute upper-GI bleeding were randomized to either urgent endoscopy (before hospitalization) or elective endoscopy after admission. The results of urgent endoscopy and a recommendation regarding patient disposition were provided to the attending physician. Medical outcomes and resource utilization were measured.
  
  
  RESULTS
  The timing of endoscopy did not affect resource utilization or patient outcomes. Length of stay was similar (urgent endoscopy, OR 3.98 days: 95% CI[2.84, 5.11] vs. elective endoscopy, OR 3.26 days: 95% CI[2.32, 4.21], p=0.45). The mean number of days in an intensive care unit was the same (1.2 days). The urgent endoscopy group had more high-risk endoscopic lesions (15 vs. 9; p=0.031). Outpatient care was recommended for 19 patients (40%). Only 4 patients were discharged.
  
  
  CONCLUSIONS
  Urgent endoscopy did not reduce hospitalization or resource utilization because the results of early endoscopy did not impact the decision by attending physicians regarding admission. For early (triage) endoscopy to impact resource utilization, the results of endoscopy must change subsequent patient care.
authors.affiliation: Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah 84132-2101, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bjorkman
authors.forename: Atif
authors.initials: A
authors.lastname: Zaman
authors.forename: M Brian
authors.initials: MB
authors.lastname: Fennerty
authors.forename: David
authors.initials: D
authors.lastname: Lieberman
authors.forename: James A
authors.initials: JA
authors.lastname: Disario
authors.forename: Ginger
authors.initials: G
authors.lastname: Guest-Warnick
mesh_terms: D000208:Acute Disease; D004381:Duodenal Ulcer / Q000150:complications; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence