Dificultades y controversias en el manejo hospitalario de la hemorragia digestiva baja

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objetivos: la hemorragia digestiva baja (HDB) es una causa frecuente de ingreso hospitalario; pese a ello, no se conocen con exactitud los factores que influyen en su evolución. Los objetivos de este trabajo fueron comparar los cambios en el manejo de la HDB en nuestro Servicio entre los años 2005 y 2007, así como analizar diferentes parámetros que pudieran influir en su pronóstico. Pacientes y métodos: se incluyeron retrospectivamente todos los ingresos por HDB durante el periodo 2005-2006 y prospectivamente los del 2006-2007. En todos se realizó historia clínica, exploración -incluyendo tacto rectal- y análisis sanguíneo. Se realizó colonoscopia en la mayoría de los pacientes. Resultados: se incluyeron 137 pacientes en el 2005-2006: requirieron transfusión de hemoderivados el 36%. El 31% había presentado algún episodio de HDB previamente. El 62% presentó una evolución favorable. El tiempo desde el ingreso hasta la colonoscopia y la estancia media fueron de 4,1 y 10,2 días respectivamente. En el 2006-2007 se incluyeron 96 pacientes: requirieron transfusión el 42%. El 33% había presentado HDB previamente. La evolución fue favorable en el 67%. El tiempo hasta la colonoscopia y la estancia media fueron de 2,6 y 7,7 días respectivamente. Los divertículos fueron el hallazgo más frecuente en ambos periodos. Conclusiones: durante el 2006-2007 la estancia media de los pacientes con HDB ingresados en el Servicio de Aparato Digestivo se redujo respecto al 2005-2006 en un 25% y el tiempo de realización de la colonoscopia en un 37%; esto no logró más localizaciones del punto sangrante ni una disminución en la recurrencia de la hemorragia.

Translated abstract

Objectives: lower intestinal bleeding (LGIB) is a frequent reason for hospitalization; however, the prognostic factors have not been clearly defined. The aim of this paper was to analyze several clinical parameters and the management of this entity in our department from 2005 to 2007. Material and methods: all hospitalized patients with LGIB were retrospectively (2005-2006) and prospectively (2006-2007) included. Medical records, physical examination (anal digital examination included), blood testing, and colonoscopic examination (in most of patients) were performed. Results: 137 patients were included during 2005-2006: 36% of them required blood transfusion; thirty-one percent of patients showed previous episodes of LGIB, and 62% had a favorable outcome. Time from admission to colonoscopy was 4.1 days, and length of stay was 10.2 days. In the 2006-2007 study 96 patients were included: 42% of them required blood transfusion, thirty-three percent of patients showed previous episodes of LGIB, and 68% had a favorable outcome. Time from admission to colonoscopy was 2.6 days, and length of stay was 7.7 days. The most frequent etiology was diverticulosis in both studies. Conclusions: hospital length of stay and time from admission to colonoscopy in patients with LGIB was reduced by 25% and 37%, respectively, in the 2005-2006 period with regard to the 2006-2007 one; however, there were no more bleeding points or a decrease in bleeding recurrence.

Related collections

Most cited references 29

Record: found
Abstract: found
Article: not found

Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial.

S Branch, Steve Guarisco, Paul S. Jowell … (2005)

We hypothesized that early intervention in patients with lower gastrointestinal bleeding (LGIB) would improve outcomes and therefore conducted a prospective randomized study comparing urgent colonoscopy to standard care. Consecutive patients presenting with LGIB without upper or anorectal bleeding sources were randomized to urgent purge preparation followed immediately by colonoscopy or a standard care algorithm based on angiographic intervention and expectant colonoscopy. A total of 50 patients were randomized to each group. A definite source of bleeding was found more often in urgent colonoscopy patients (diverticula, 13; angioectasia, 4; colitis, 4) than in the standard care group (diverticula, 8; colitis, 3) (the odds ratio for the difference among the groups was 2.6; 95% CI 1.1-6.2). In the urgent colonoscopy group, 17 patients received endoscopic therapy; in the standard care group, 10 patients had angiographic hemostasis. There was no difference in outcomes among the two groups-including: mortality 2%versus 4%, hospital stay 5.8 versus 6.6 days, ICU stay 1.8 versus 2.4 days, transfusion requirements 4.2 versus 5 units, early rebleeding 22%versus 30%, surgery 14%versus 12%, or late rebleeding 16%versus 14% (mean follow-up of 62 and 58 months). Although urgent colonoscopy identified a definite source of LGIB more often than a standard care algorithm based on angiography and expectant colonoscopy, the approaches are not significantly different with regard to important outcomes. Thus, decisions concerning care for patients with acute LGIB should be based on individual experience and local expertise.

0 comments Cited 76 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists.

T Eisenbach, A Sieg, U Hachmoeller-Eisenbach (2001)

Although most diagnostic GI endoscopic procedures in Germany are performed on an outpatient basis, there is no large-scale prospective evaluation of complication rates. Ninety-four gastroenterologists and internists from all regions of Germany recorded the number of EGD, colonoscopies, and polypectomies performed over a period of 1 year. All serious complications occurring in relation to the procedure, including the use of medication, were recorded in a structured protocol. A total of 110,469 EGDs, 82,416 colonoscopies, and 14,249 polypectomies were evaluated. The "reach-the-cecum-rate" was 97% (median). The overall complication rates for EGD, colonoscopy, and polypectomy were low compared with published data (0.009%, 0.02%, and 0.36%, respectively). The perforation rates were 0.0009%, 0.005%, and 0.06%, respectively, the rates of significant hemorrhage 0.002%, 0.001%, and 0.26%, respectively, and the mortality rates 0.0009%, 0.001%, and 0.007%, respectively. The rates of cardiorespiratory complications associated with EGD and colonoscopy were 0.005% and 0.01%, respectively. The overall complication rate for all procedures (diagnostic and therapeutic) was lower for gastroenterologists (1 per 5155 procedures) than internists (1 per 1539 procedures). Most of the adverse events associated with diagnostic endoscopy were attributable to use of medication. The severity score ranged from 2 to 5 for most of the adverse events occurring as a result of diagnostic procedures and 2 to 50 for polypectomy. The severity sum score per 10,000 procedures was 26 for EGD, 67 for colonoscopy, and 1185 for polypectomy. Outpatient endoscopy performed in practice settings by German gastroenterologists and internists is safe. The low complication rates may partly be explained by the high degree of experience resulting from the larger numbers of procedures performed relative to the numbers performed by gastroenterologists in hospitals and in other countries.

0 comments Cited 67 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Early predictors of severity in acute lower intestinal tract bleeding.

Lisa Strate, E. Orav, Sapna Syngal (2003)

Identification of high-risk patients with lower intestinal tract bleeding (LIB) is challenging, and prognostic factors have not been clearly defined. The aim of this study was to determine risk factors for severe acute LIB. A total of 252 consecutive patients admitted with acute LIB were identified. Data were collected on 24 clinical factors available in the first 4 hours of evaluation. The outcome was severe bleeding, which was defined as continued bleeding within the first 24 hours of hospitalization (transfusion of > or = 2 units of blood and/or hematocrit decrease of > or = 20%) and/or recurrent bleeding after 24 hours of stability (additional transfusions, further hematocrit decrease of > or = 20%, or readmission for LIB within 1 week of discharge). Severe LIB occurred in 123 patients (49%). Independent correlates of severe bleeding were as follows: heart rate, > or = 100/min (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.78-7.57); systolic blood pressure, < or = 115 mm Hg (OR, 3.45; 95% CI, 1.54-7.72); syncope (OR, 2.82; 95% CI, 1.06-7.46); nontender abdominal examination (OR, 2.43; 95% CI, 1.22-4.85); bleeding per rectum during the first 4 hours of evaluation (OR, 2.32; 95% CI, 1.28-4.20); aspirin use (OR, 2.07; 95% CI, 1.12-3.82); and more than 2 active comorbid conditions (OR, 1.93; 95% CI, 1.08-3.44). Clinical data available on initial evaluation can be used to identify patients at risk for severe LIB, who may benefit most from urgent intervention.