Abstract
The etiologic diagnosis and specific treatment of patients with obscure gastrointestinal bleeding (OGIB) usually imply the repetition of various endoscopic and imaging tests, multiple blood transfusions and hospitalizations, with increased risks and costs for the patients and the health system. To develop a protocol designed for screening and treatment of the OGIB and to evaluate the impact of the same protocol on the cost-effectiveness in a tertiary teaching hospital setting. This is an observational study involving data collected retrospectively (before protocol) and also obtained prospectively (after protocol). Medical records of patients managed between 2002 and 2016, according or not the protocol for screening and treatment of OGIB, were evaluated. Epidemiological, clinical and costs variables were analyzed. Among the 100 patients with OGIB studied, 82 (82%) were managed without the protocol (non-protocol group or NPG) and 18 (18%) with the clinical protocol (protocol group or PG). The number of specific tests used to evaluate the bleeding was 7.2 per patient in the NPG and 5.17 in the PG (p <0.01). Compared to NPG, patients in the PG performed less imaging tests, such as CT, but more capsule endoscopy and double balloon enteroscopy (see Fig. 1). Blood transfusions were performed in 64 patients (78.05%) in the NPG and in 9 patients (50%) in the PG (p = 0.02). Mortality and transfusion of fresh frozen plasma, platelets, and cryoprecipitate were not different between groups. The mean time to reach the diagnosis was 309.9 weeks in the NPG and 18.3 weeks in the protocol group (p <0.01). The average cost per patient was higher in the NPG, (US$ 14,153.51) compared to the PG (US$ 3,226.65) (p <0.01). The adoption of a protocol for the management of OGIB in a tertiary care hospital resulted in more use of capsule endoscopy and double balloon enteroscopy, but lower costs and better cost-effectiveness.
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