Medical care setting is associated with survival in acute upper gastro-intestinal bleeding: A cohort study.

BACKGROUND: There are limited data on the effect of the medical care setting on survival in patients admitted with acute upper gastrointestinal bleeding. AIMS: To identify the organisational and care setting which provides the optimal survival in patients with acute upper gastrointestinal bleeding. METHODS: A retrospective observational study of administrative data from a cohort of patients admitted to a Regional or Local hospital, and cared for in a gastroenterology or general ward. PRIMARY OUTCOME: 30 day survival for non-variceal bleeding and 42 day survival for variceal bleeding. RESULTS: Out of 3368 patients, the source of bleeding was non-variceal in 2980 (88.5%). Survival, adjusted for clinical and organisational factors, was higher in patients admitted to a gastroenterology ward vs other wards (OR = 2.02 p < 0.0006). Management in a gastroenterology ward in a Regional hospital provided a higher survival rate (95.6% ±â€¯0.08) vs a non-gastroenterology ward in a Local hospital (92.9% ±â€¯0.05 p < 0.01) or a non-gastroenterology ward in a Regional hospital (89.5% ±â€¯0.01 p < 0.0001). Survival (94.0% ±â€¯1.6) in a Local hospital with a gastroenterology ward was significantly higher than in a Regional hospital without (89.5% ±â€¯1.1) p < 0.01. CONCLUSION: Survival was optimal for patients treated in a gastroenterology ward independently of Regional or Local hospital setting.

A prospective cohort study evaluating a novel colonoscopy platform featuring full-spectrum endoscopy.

BACKGROUND AND STUDY AIMS: Although colonoscopy is the criterion standard for detecting colorectal adenomas and cancers, a significant percentage of adenomas are missed with this technique. We aimed to establish the feasibility, usability, and safety of a novel colonoscopy platform featuring full-spectrum endoscopy (FUSE). PATIENTS AND METHODS: This was a prospective, single-center pilot and feasibility study. In total, 50 individuals, ages 18 - 70 years, underwent colonoscopy featuring FUSE (up to 330° field of view) for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. Study end points included success of cecal intubation, time to cecal intubation, withdrawal time, total procedure time, success of therapeutic interventions, adverse events, and endoscopists' subjective evaluation of FUSE. RESULTS: Cecal intubation was achieved in 50/50 individuals (100 %). Time to cecum (minutes, mean ± SD) was 3.1 ± 1.5 minutes, withdrawal time 12.7 ± 4.4 minutes, and total procedure time 15.3 ± 4.6 minutes. In 22/50 cases (44 %), 26 therapeutic interventions were performed: 19 (73.1 %) biopsies and 7 (26.9 %) polypectomies. No acute or delayed adverse events were observed. Patient satisfaction and endoscopist subjective evaluation were high. CONCLUSIONS: A colonoscopy platform featuring full-spectrum endoscopy appears feasible, usable, and safe. These results represent an important advance in colonoscopy imaging technology and should be further pursued in comparative human studies.