The outcome of suspected upper gastrointestinal bleeding with 24-hour access to upper gastrointestinal endoscopy: a prospective cohort study.

Background and Study Aim: The aim was to evaluate the 30-day mortality after endoscopy for suspected upper gastrointestinal bleed, following the implementation of national audit guidelines at our hospital. Patients and Methods: All patients with suspected upper gastrointestinal bleeding, referred for endoscopy to our teaching hospital between October 2001 and December 2003, were included in a prospective cohort study. Results: A total of 716 patients with suspected upper gastrointestinal tract haemorrhage were referred for urgent endoscopy. The median age was 69 years (interquartile range 51-80 years). Bleeding from peptic ulcer remained the single most common endoscopic diagnosis (40%). The overall re-bleeding rate for all patients with a gastrointestinal haemorrhage was 10%. The overall 30-day mortality rate was 14.6%. This was not significantly different from the mortality rate in 1995 of 10.5% (P=0.11). Patients who died were significantly older (78 vs. 67 years, 95%CI of the difference 5 to 12, P < 0.001). However, in only 29% (30/ 105) was gastrointestinal haemorrhage stated in the death certificate as a factor which contributed to their death. Conclusions: Our results show that implementing the good practice guideline has a limited impact on overall mortality because of contributing factors that are beyond the control of clinicians.