Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit.

Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p = 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p = 0.004), but not 30-d mortality (p = 0.344). Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

Systematic review and meta-analysis: does colonic mural thickening on CT correlate with endoscopic findings at colonoscopy?

BACKGROUND: Colonic mural thickening (MT) is often reported on standard CT examinations of the abdomen and pelvis. It often presents a dilemma for the clinician on whether any further evaluation is needed, especially in the absence of any set guidelines. OBJECTIVE: To evaluate the significance of colonic MT and to assess its correlation with colonoscopy. METHODS: The search strategy was initially developed in Medline and adapted for use in Embase, Medline, NHS Evidence and TRIP. Studies were included if they had reported colonic MT and subsequent colonoscopy in adults. RESULTS: A total of 9 cohort studies examining 1252 patients were selected having undergone both CT and colonoscopy. Of the 1252 patients with MT, 950 had an abnormal colonoscopy. In the presence of MT, the pooled positive predictive value (PPV) of having any abnormal findings at colonoscopy was 0.73 (95% CI 0.60 to 0.84). The pooled PPV for colorectal cancer, in the presence of MT reporting suspicion of cancer, was 0.63 (95% CI 0.49 to 0.75), and MT suggestive of inflammation confirmed at colonoscopy was 0.97. CONCLUSION: The probability of having an abnormal colonoscopy in the presence of MT identified on CT is high, especially for inflammation. Asymptomatic cancers may also be detected; hence, further endoscopic confirmation is reasonable when a finding of MT is demonstrated on CT examinations. Small sample sizes of the available studies and lack of data on the description of MT detected are the main limiting factors in this review. TRIAL REGISTRATION NUMBER: CRD42016039378.

Colonic thickening on computed tomography-does it correlate with endoscopic findings? A protocol for systematic review.

BACKGROUND: Colonic mural thickening is often a finding in standard computed tomography (CT) scans of the abdomen. It often presents clinician with a dilemma on when a further endoscopic evaluation is needed, especially in the absence of guidelines. The aim of this systematic review is to evaluate the significance of bowel wall thickening and to assess its correlation with endoscopy. METHODS: This systematic review will be reported in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. The search strategy will initially be developed in MEDLINE and adapted for use in EMBASE, MEDLINE, NHS evidence and TRIP. Two reviewers will independently conduct a study selection, data extraction and risk of bias assessment for the screened studies. Data synthesis will be conducted using Review Manager software 5.3. The outcome of any dichotomous data will be presented as relative risk with confidence intervals. DISCUSSION: It is extremely useful for the practising clinician to know which patients need further endoscopic evaluation. Even though there are several studies on this issue, none of them have attempted to produce a systematic review. We hope this systematic review will provide a substantiate evidence for future clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039378.