OUTPATIENT CARE OF SELECTED PATIENTS WITH ACUTE NONVARICEAL UPPER GASTROINTESTINAL HEMORRHAGE

Patients with upper gastrointestinal haemorrhage (UGIH) are usually cared for in hospital. To evaluate the efficacy and safety of outpatient care of selected patients with acute non-variceal UGIH who had endoscopy, we retrospectively analysed 4.5 years' experience of patients treated without hospital admission. We developed practice guidelines for outpatient care, and prospectively studied patients treated during the first 6 months of their use. 78 (8.4%) of 933 patients in the retrospective series and 34 (24.1%) of 141 in the prospective series received outpatient care. The guidelines comprised early notification of a gastroenterologist, urgent endoscopy, clinical, laboratory, and endoscopic criteria for outpatient care, and details of care. In the prospective study patients treated as outpatients were younger than those admitted (52.8 [SE 3.6] vs 63.0 [1.5] years) and had a slightly longer time from onset of bleeding to endoscopy (2.4 [0.2] vs 2.1 [0.2] days). Outpatients were less likely to have alcoholism, other major concomitant disease, syncope or presyncope, or supine tachycardia. Outpatients had higher haemoglobin concentrations than inpatients (125 [4] vs 106 [3] g/L). Most patients in both groups had peptic ulcers. There were no complications in the retrospective series; 1 of the 34 prospective outpatients was admitted with rebleeding. All outpatients survived. The estimated hospital cost saved per outpatient was about $990. A substantial proportion of carefully selected patients with acute non-variceal UGIH can be effectively cared for without admission to hospital.