PTU-063 Upper gastrointestinal bleeding (AUGIB) in sierra leone – audit of outcomes when minimal endoscopy access

Sierra Leone is a developing country in W. Africa. Medical facilities are rudimentary. There was no gastroscopy service till 2016, when supported by a grant from the British Society of Gastroenterology (BSG), 4 gastroenterologists from northeast UK travelled to the capital, Freetown. We trained 3 doctors to perform gatroscopy (OGD). Since then we have supported the doctors remotely and by annual visits. They have done procedures in private hospital that owns endoscopy stack. Aims No endoscopy equipment exists in Government sector. We felt that we should demonstrate the need for a service by concentrating on the management of a distinct clinical entity, AUGIB, in which the benefit of OGD is clear. We undertook an audit of UGIB presenting to the main government hospital in Freetown (Connaught Hospital) to look at clinical presentation and outcomes. Method 2 house officers (HO’s) allocated to collect data. The audit was publicised at weekly medical meetings and also, details were put in the hospital medical WhatsApp group. HO’s visited outpatient department regularly to identify patients. Then, as record keeping is paper based and poor, they visited regularly to keep a record of clinical details results and outcomes. A proforma developed by the UK team and head of medicine was used to record demographic clinical and outcome details. Details from the proforma were transcribed on to an excel spreadsheet. Results 24 patients identified in the period. 63.6% male. Median age- 45 (26–67); Symptom duration at presentation - 3 days (0.5–28). 10 patients had haematemesis, 2 melaena and 12 with both. None taking anticoagulant/antiplatetelet drugs. 2 patients on non NSAID. Significant comorbidities as follows; Hep B +ve – 2 (one clinically cirrhotic); HIV +ve - 1. One patient had previous AUGIB. Clinical parameters on admission as follows: Median haemoglobin – 5 g/dl (2–13.5); Median systolic BP – 98.5 mmHg (60–224); Median pulse – 115/min (80–146). 21 patients had at least one dose of IV Omeprazole. 15 patients had at least 1 unit of blood ((median Hb = 5 (2–7.3)). A single patient (Female aged 56) with admission Hb of 5 g/dL underwent OGD day 7 of admission: Diagnosis – erosive oesophagitis. 15 patients discharged after mean 11.3 days (5–27). 8 patients died giving crude mortalty –3.4%. Mean time to death 3. Days (0–12). Conclusion This 1st audit of outcomes of AUGIB in Sierra Leone shows a comparatively high mortality in relatively young patients. Reasons for this probably multifactorial. However, lack of access to endoscopy probably a contributory factor. We have developed a AUGIB bundle which we hope to administer whilst waiting for the government to invest in endoscopy equipment.