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BACKGROUND: There are limited data on the effect of the medical care setting on survival in patients admitted with acute upper gastrointestinal bleeding.AIMS: To identify the organisational and care setting which provides the optimal survival in patients with acute upper gastrointestinal bleeding.METHODS: A retrospective observational study of administrative data from a cohort of patients admitted to a Regional or Local hospital, and cared for in a gastroenterology or general ward.PRIMARY OUTCOME: 30 day survival for non-variceal bleeding and 42 day survival for variceal bleeding.RESULTS: Out of 3368 patients, the source of bleeding was non-variceal in 2980 (88.5%). Survival, adjusted for clinical and organisational factors, was higher in patients admitted to a gastroenterology ward vs other wards (OR = 2.02 p CONCLUSION: Survival was optimal for patients treated in a gastroenterology ward independently of Regional or Local hospital setting.

Acute upper gastrointestinal bleeding (UGIB) is a frequent condition worldwide. The most common causes of acute nonvariceal UGIB include ulcers and nonulcer etiology, such as mucosal erosive disease, Mallory-Weiss tear, Dieulafoy, and other vascular lesions. Today patients are older and more likely to have comorbidities and concomitant treatments: anticoagulants, antiplatelet agent, low dose aspirin or steroidal anti-inflammatory drugs. In these patients with UGIB the rebleeding risk, need for surgery, and mortality rates are higher. Mechanical therapy using through-the-scope clips leads to a substantially reduced rebleeding risk and requirement for surgery compared with injections alone. The addition of injection therapy to mechanical treatment confers no further clinical advantage; clip compared with thermocoagulation had no improvement in definitive hemostasis, surgery or death, alone or in combination with injection. In patients with Dieulafoy or angiodysplasia or both, clipping and endoscopic band ligation are more effective and successful in achieving hemostasis when compared to injection. The available data are insufficient to consider over-the-scope clip as second-line therapy after the failure of conventional endoscopic treatment.

Background. Split bowel preparation is the best regimen for colonoscopy. However, the same-day regimen can represent a valid alternative, but its use is limited by concerns about its cleansing ability, and to date, no convincing data support its use for routine colonoscopies. Aim. To evaluate the cleansing, compliance, and adverse event rates of the same-day compared to the split regimen. Results. A systematic literature search and meta-analysis was performed. Ten studies were included for a total of 1807 patients (880 in the same-day group and 927 in the split group). Overall, 85.3% patients in the same-day group vs. 86.3% in the split group had an adequate cleansing. Compliance was high for both, although patients were more compliant with the split than with the same-day prep (89.7% for same-day vs. 96.6% for split regimen). Sleep disturbance was more frequent in the split group, while nausea and vomit were more frequent in the same-day group. In the subgroup analysis, polyethylene glycol obtained a better cleansing rate when given as a split dose, with similar compliance and adverse events rates with both regimens. Conclusion. Split and same-day regimens are both useful in bowel cleaning before colonoscopy with a different pattern of adverse events and better compliance for split preparations. Endoscopists can consider the same-day preparation as a valid alternative, especially when the split preparation does not fit the patients’ needs.

Nowadays, capsule endoscopy (CE) is the first-line procedure after negative upper and lower gastrointestinal (GI) endoscopy for obscure gastrointestinal bleeding (OGIB). Approximately, two-thirds of patients undergoing CE for OGIB will have a small-bowel abnormality. However, several patients who underwent CE for OGIB had the source of their blood loss in the stomach or in the colon. The aim of the present study is to determine the incidence of bleeding lesions missed by the previous gastroscopy/colonoscopy with CE and to evaluate the indication to repeat a new complete endoscopic workup in subjects related to a tertiary center for obscure bleeding before CE.We prospectively reviewed data from 637/1008 patients underwent to CE for obscure bleeding in our tertiary center after performing negative gastroscopy and colonoscopy.CE revealed a definite or likely cause of bleeding in stomach in 138/637 patients (yield 21.7%) and in the colon in 41 patients (yield 6.4%) with a previous negative gastroscopy and colonoscopy, respectively. The lesions found were outside the small bowel in only 54/637 (8.5%) patients. In 111/138 patients, CE found lesions both in stomach and small bowel (small-bowel erosions in 54, AVMs in 45, active small-bowel bleeding in 4, neoplastic lesions in 3 and distal ileum AVMs in 5 patients). In 24/41 (58.5%) patients, CE found lesions both in small bowel and colon (multiple small-bowel erosions in 15; AVMs in 8 and neoplastic lesion in 1 patients. All patients underwent endoscopic therapy or surgery for their nonsmall-bowel lesions.Lesions in upper or lower GI tract have been missed in about 28% of patients submitted to CE for obscure bleeding. CE may play an important role in identifying lesions missed at conventional endoscopy.