Same Day Bidirectional Outpatient Endoscopy for Suspected Gastroenterology Bleeding at Veterans Affairs Tertiary Referral Center

Abstract

Purpose: Patients (Pts) with minor gastrointestinal (GI) bleeding are often scheduled for expedited outpatient EGD and colonoscopy on the same day at our institution. Our aim was to determine the diagnostic yield of scheduling bidirectional outpatient procedures for minor GI bleeding and to determine if the pre-test data can predict the test yield to conclude whether this practice should continue or be modified. Methods: We reviewed all records of outpatients who had EGD and colonoscopy scheduled the same day in 2005 at Veterans Affairs Medical Center, Buffalo. Our study population included pts with minor GI bleed which was defined as occult GI bleeding with or without iron deficiency anemia or iron deficiency anemia alone. Pts with melena were also included if EGD/Colonoscopy were performed as outpatient. Base line laboratories including: CBC, INR, BUN, Creatinine, iron studies and Fecal Occult Blood Test (FOBT) status were recorded. GI symptoms, number of blood transfusion and hospital admission in one year prior to the procedure were obtained as well. Significant EGD findings include: ulcer (Duodenal, Gastric), portal Hypertension, gastropathy, varices, mild gastritis, superficial erosions, mild duodenitis, friable mucosa, Arterio-Venous Malformations and active bleeding. Non-significant findings include: normal study, candida infection, hiatal hernia, polyps, Barrett's esophagus, Schatzki's ring and lipomas. Multivariate regression analysis conducted. Results: Total of 91 pts (Male=88; Female=3) were included in the study. 81 were white and 10 African American. Median age was 68. Study indications were: Iron deficiency without anemia (n=4), Iron deficiency with anemia (n=42), FOBT positive without anemia (n=14), FOBT positive with anemia (n=28), and melena with anemia (n=2). Significant medications received within one month prior to the study were Aspirin (n=28), Nonsteroidal anti inflammatory drugs (n=14), Plavix (n=12) and Coumadin (n=12). Upper GI symptoms were reported by 25 pt including nausea, vomiting, dysphagia, abdominal pain or heartburn while 5 had lower GI symptoms as change in bowel movement habits. Only 17 pts had significant findings while 74 had non-significant ones (including 37 normal studies). Our analysis revealed no statistically significant correlation between any of the baseline labs mentioned above or the GI symptoms and the results of the EGD. Conclusion: In summary we were unable to find any pre-procedure predictive factor that can help in deciding the endoscopic procedure of choice in pts with minor GI bleed. The study is limited with sample size, recommend following prospective studies.