1. Acute variceal bleeding and out-of-hours endoscopy: Evaluation of an emergency care setting according to Baveno VI guidelines adherence.
- Author
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Alves da Silva J, Falcão D, Maia L, Guedes TP, Garrido M, Novo MI, Rocha M, Pinto P, Moreira T, Ferreira JM, and Pedroto I
- Subjects
- After-Hours Care statistics & numerical data, Aged, Esophageal and Gastric Varices epidemiology, Esophageal and Gastric Varices etiology, Female, Gastrointestinal Hemorrhage epidemiology, Gastrointestinal Hemorrhage etiology, Hospitalization statistics & numerical data, Humans, Liver Cirrhosis complications, Male, Middle Aged, Portugal epidemiology, Retrospective Studies, Emergency Service, Hospital standards, Endoscopy, Gastrointestinal statistics & numerical data, Esophageal and Gastric Varices therapy, Gastrointestinal Hemorrhage therapy, Guideline Adherence
- Abstract
Background: The extent to which patients with acute variceal bleeding (AVB) receive recommended care is largely unknown., Aim: to evaluate the adherence of the 4 major Baveno VI recommendations [vasoactive agents, prophylactic antibiotic, esophagogastroduodenoscopy (EGD) within 12 hours, endoscopic variceal ligation (EVL)] as a marker of quality of an emergency model., Methods: Retrospective evaluation of AVB admissions to a tertiary centre in which endoscopy was available 24hours-a-day, with a regional out-of-hours service at night (the furthest hospital is 200Km away). Patients were divided in directly admitted or transferred from other centres., Results: 210 AVB patients were included; 101 (48.1%) were directly admitted. The majority of patients were submitted to vasoactive agents (85.7%) and prophylactic antibiotics (79%) before EGD. In 178 patients (84.8%) endoscopy was performed within 12h and EVL was the procedure of choice in 116 (74.8%) (only oesophageal varices). No significant differences were observed between directly admitted and transferred patients in adherence rates. Overall rebleeding rate was 8.6%, in-hospital mortality 11.4% and 6-week mortality 20%., Conclusion: Adherence to quality metrics was high which might have played a vital role for reported outcomes. These results suggest that this model of care, provides accessibility and equity in access to urgent endoscopy., Competing Interests: Declaration of Competing Interest The authors have no conflict of interests to declare., (Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2021
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