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Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit

Siau, Keith; Hodson, James; Ingram, Richard; Baxter, Andrew; Widlak, Monika M.; Sharratt, Caroline; Baker, Graham M.; Troth, Tom; Hicken, Ben; Tahir, Faraz; Magrabi, Malik; Yousaf, Nouman; Grant, Claire; Poon, Dennis; Khalil, Hesham; Lee, Hui Lin; White, Jonathan R.; Tan, Huey; Samani, Syazeddy; Hooper, Patricia; Ahmed, Saeed; Amin, Muhammad; Mahgoub, Sara; Asghar, Khayal; Leet, Farique; Harborne, Matthew J; Polewiczowska, Beata; Khan, Sheeba; Anjum, Muhammad R.; McFarlane, Michael; Mozdiak, Ella; O’Flynn, Lauren D.; Blee, Ilona C.; Molyneux, Rachel M.; Kurian, Ashok; Abbas, Syed N; Abbasi, Abdullah; Karim, Aadil; Yasin, Asif; Khattak, Fawad; White, Josephine; Ahmed, Ruhina; Morgan, James A.; Alleyne, Lance; Alam, Mohamed A.; Palaniyappan, Naaventhan; Rodger, Victoria J.; Sawhney, Paramvir; Aslam, Nasar; Okeke, Theodore; Lawson, Adam; Cheung, Danny; Reid, Jeremy P.; Awasthi, Ashish; Anderson, Mark R.; Timothy, Joe R.; Pattni, Sanjeev; Ahmad, Saqib; Townson, Gillian; Shearman, Jeremy;...


Keith Siau

James Hodson

Richard Ingram

Andrew Baxter

Monika M. Widlak

Caroline Sharratt

Graham M. Baker

Tom Troth

Ben Hicken

Faraz Tahir

Malik Magrabi

Nouman Yousaf

Claire Grant

Dennis Poon

Hesham Khalil

Hui Lin Lee

Jonathan R. White

Huey Tan

Syazeddy Samani

Patricia Hooper

Saeed Ahmed

Muhammad Amin

Sara Mahgoub

Khayal Asghar

Farique Leet

Matthew J Harborne

Beata Polewiczowska

Sheeba Khan

Muhammad R. Anjum

Michael McFarlane

Ella Mozdiak

Lauren D. O’Flynn

Ilona C. Blee

Rachel M. Molyneux

Ashok Kurian

Syed N Abbas

Abdullah Abbasi

Aadil Karim

Asif Yasin

Fawad Khattak

Josephine White

Ruhina Ahmed

James A. Morgan

Lance Alleyne

Mohamed A. Alam

Victoria J. Rodger

Paramvir Sawhney

Nasar Aslam

Theodore Okeke

Adam Lawson

Danny Cheung

Jeremy P. Reid

Ashish Awasthi

Mark R. Anderson

Joe R. Timothy

Sanjeev Pattni

Saqib Ahmad

Gillian Townson

Jeremy Shearman

Vanja Giljaca

Ben R Disney

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Professor of Hepatology

Titus Thomas

Anthony Norman

Peter Wurm

Ashit Shah

Neil C. Fisher

Sauid Ishaq

Giles Major


Background: Endoscopy within 24 hours of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24h of admission).

Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between Nov-Dec 2017. Analyses were performed to identify factors
associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups.

Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2h (IQR 12.0- 35.7), comprising median admission to referral and referral to endoscopy times of 8.1h (IQR 3.7- 18.1) and 6.7h (IQR 3.0-23.1) respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0% - 87.5%, p=0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7am-7pm or via the Emergency Department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1d; p= 0.004), but not 30-day mortality (p=0.344).

Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.


Siau, K., Hodson, J., Ingram, R., Baxter, A., Widlak, M. M., Sharratt, C., …Major, G. (2018). Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit. United European Gastroenterology Journal,

Journal Article Type Article
Acceptance Date Oct 15, 2018
Online Publication Date Oct 28, 2018
Publication Date Oct 28, 2018
Deposit Date Jan 31, 2019
Publicly Available Date Feb 1, 2019
Print ISSN 2050-6406
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Keywords Upper gastrointestinal bleeding, haemorrhage, time to endoscopy, endoscopy, quality
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