PTH-109 The bottom line: real world management of acute lower gastrointestinal bleeding compared to BSG guidelines

Published Date: 07th November 2021

Publication Authors: Baig D

Introduction
Lower gastrointestinal bleeding (LGIB) is a common hospital presentation, from self-limiting per-rectal bleeding to a life-threatening haemorrhage. British Society of Gastroenterology (BSG) acute LGIB guidelines define a clear management approach including risk stratification for patient management. However, real-world management of LGIB in relation to this guidance is currently unknown.

Methods
Patients aged ≥16 years presenting with LGIB to 7 hospital trusts from June 1st–Aug 31st 2019 were included. Data on presentation, management and outcomes of patients were recorded. These were audited against BSG guidelines.

Results
407 patients were included. 51% were male with a mean age of 60 (SD = 22). Mean Shock Index (SI) at presentation was 0.69, with a SI ≥ 1 being rare (6.3%). 2.2% (9/407) of patients remained haemodynamically unstable (SI >1) after initial resuscitation. Of these, 22.2% underwent a computed tomogram angiography (CTA). Within the major bleed risk patients (Oakland Score >8); 284 (85%) were admitted and 50 (15%) were discharged from A&E. For minor bleed risk patients (Oakland Score ≤8); 67.9% and 32.1% were admitted and discharged respectively. Complete Oakland Score data was unavailable for 7 patients. Of admitted patients, colonoscopy and sigmoidoscopy was performed in 4.3% and 14.6% respectively, whilst 81.8% underwent no inpatient LGI endoscopy. A bleeding site was seen in 12 (20%) patients at endoscopy, for which 2 (10%) received endoscopic therapy. 7-day rebleeding rates were higher in patients who underwent LGI endoscopy versus those conservatively managed (16.7% vs 7.5%, p=0.028). Inpatient mortality was low at 2.1%, with no difference in major vs minor bleed patients (2.1% vs 2.6%, p=1.0). Median length of stay was 5.5 days in patients who received LGI endoscopy and 2 days for those conservatively managed (p= < 0.00001). 15.3% of patients were managed in accordance with BSG guidance. The most common deviations being patients with an Oakland Score >8 being discharged and admitted patients not undergoing LGI endoscopy.

Conclusion
Real world practice of managing patients presenting with LGIB is not in keeping with current BSG guidelines, with admission or discharge often not in keeping with Oakland Scores. The majority of admitted patients do not receive inpatient LGI endoscopy, in patients who do, endoscopic therapy is rarely indicated.

Davies, M; Baid, D et al. (2021). PTH-109 The bottom line: real world management of acute lower gastrointestinal bleeding compared to BSG guidelines . Gut. 70 (4), A168.

« Back