Supplementary appendix

Size: px
Start display at page:

Download "Supplementary appendix"

Transcription

1 Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Oakland K, Jairath V, Uberoi R, et al. Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study. Lancet Gastroenterol Hepatol 17; published online June 3.

2 Supplementary Table 1: Previously described risk scores for upper and lower gastrointestinal bleeding Score Variables Predicted Outcomes PRE-ENDOSCOPY ROCKALL 1 BLATCHFORD BLEED 3 AIMS65 4 STRATE 5 NOBLADS 6 Age On-going bleeding Albumin <3g/l HR 1 <6 SBP<1 INR>1.5 SBP PT>1. Altered mental status Syncope > Erratic mental status SBP 9 Non-tender abdominal examination Shock Unstable co-morbid disease Age>65 Bleeding per rectum in first 4 hours of No shock (defined as organ presentation HR>1 and SBP>1 derangement requiring ICU Aspirin use SBP<1 admission) > active Charslon co-morbid conditions Co-morbidity Nil major CHF, IHD, any major morbidity renal failure, liver failure, metastatic cancer Urea >5 Hb M 1. F M (no F) M <1 SBP <9 Other HR>=1 Melaena Syncope Hepatic disease Cardiac failure Death and re-bleeding Need for intervention In-hospital complications and mortality LOS and mortality Severe haemorrhage* used a surrogate marker of patients that will require substantial support and early interventions * NSAIDs No diarrhoea No abdominal tenderness SBP 1 Non-aspirin antiplatelet Albumin <3g/l > active Charslon comorbid conditions Severe haemorrhage*, transfusion, LOS, need for intervention * Severe haemorrhage defined as requirement of >= units red cells OR decrease in Hct of >=% in first 4 hours, OR additional transfusion OR further decrease in Hct >=% after 4 hours of clinical stability OR re-admission with LGIB within one week 7 1

3 Supplementary Table : Sources of bleeding Diverticular disease Colitis Colorectal cancer Haemorrhoids and other benign anorectal disorders Polyps Post-polypectomy Angiodysplasia Small bowel bleeding Unknown Other* Development Cohort N= (7.6) 6 (11.5) 16 (4.5) 39 (16.7) 55 (.4) 5 (.1) 3 (1.) (.3) 55 (3.5) 131 (5.6) 93 Validation Cohort N= 4 (9.) 37 (1.) 13 (4.5) 3 (13.) 7 (.4) 3 (1.) 1 (4.) 3 (1.) 6 (3.6) 6 (9.) *aortoenteric fistula, drug induced LGIB, caecal varices, arteriovenous malformation, colonic perforation, colonic endometriosis, intussusception, Meckel s diverticulum, post-endoscopic biopsy, stenting, post-trans anal endoscopic microsurgery Supplementary Table 3: The inpatient use of endoscopy and interventional radiology OGD Colonoscopy Flexible sigmoidoscopy Capsule endoscopy Endoscopic haemostasis Mesenteric angiography ± embolisation Development Cohort N= (11.) 37 9 (3.9) (.) 44 (.3) (1.) (1.4) 57 Validation Cohort N= 37 (1.) 9 67 (3.3) 43 (14.9) 1 (.3) 13 (4.5) 15 (5.)

4 Supplementary Table 4: Final prediction model for safe discharge Predictor Coefficient Standard error P-value Intercept < 1 Age Gender Previous LGIB admission DRE findings Heart rate Systolic blood pressure < 1 Haemoglobin 53 6 < 1 Supplementary Table 5: Number of patients safely discharged by score Score Safely discharged % (N) Development cohort 1. (1). () 1. (). (15) 3.3 (5) 1.7 (49). (75).9 (76) 4.5 (71) 79. (64) 5.1 (57) 71.6 (53) 1.5 (53) 76.5 (39) 56.5 (6) 51. (1) 5. (9) 34. (17) Validation cohort 1. (1) 1 () 1 () 91.7 (11) 6.7 (13) 5. (17) 76.5 (13) 76.5 (13) 3.3 (1) 61.5 () 73.7 (14) 3.3 (1) 47.1 () 69. (9). ().6 (4) 3

5 Supplementary Figure 1: Calibration plot of the final prediction model for safe discharge in the validation cohort.. 95% confidence intervals around the observed predictions (triangle) at tenths of predicted risk. Appendix References 1. Rockall TA, Logan RF, Devlin HB, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;3(3): Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. Lancet (London, England) ;356(93): Kollef MH, O'Brien JD, Zuckerman GR, et al. BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Critical care medicine 1997;5(7): Saltzman JR, Tabak YP, Hyett BH, et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 11;74(6): Strate LL, Orav EJ, Syngal S.Early predictors of severity in acute lower intestinal tract bleeding. Archives of internal medicine 3;163(7): Aoki T, Nagata N, Shimbo T, et al. Development and Validation of a Risk Scoring System for Severe Acute Lower Gastrointestinal Bleeding. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 16;14(11):156-7.e. 4

When to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA

When to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA When to Scope in Lower GI Bleeding: It Must Be Done Now Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA Outline Epidemiology Overview of available tests Urgent

More information

Improved risk assessment in upper GI bleeding

Improved risk assessment in upper GI bleeding EDITORIAL Improved risk assessment in upper GI bleeding Acute upper GI bleeding is the most common GI emergency, with a reported incidence in various epidemiological studies ranging from 50 to over 100

More information

Lower gastrointestinal bleeding (LGIB) is a common

Lower gastrointestinal bleeding (LGIB) is a common CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2004;2:485 490 Early Predictors of Severe Lower Gastrointestinal Bleeding and Adverse Outcomes: A Prospective Study FERNANDO S. VELAYOS,* ANN WILLIAMSON, KAREN

More information

Role of radiology in colo-rectal bleedings. Alban DENYS MD FCIRSE EBIR CHUV LAUSANNE

Role of radiology in colo-rectal bleedings. Alban DENYS MD FCIRSE EBIR CHUV LAUSANNE Role of radiology in colo-rectal bleedings Alban DENYS MD FCIRSE EBIR CHUV LAUSANNE Epidemiology Lower GI bleeding accounts for 20-25% of all GI bleeding Annual incidence in USA :21-27/100000 Longstreth

More information

Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor

Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment

More information

Management of Lower Gastrointestinal Bleeding. Patrick Lau Department of Surgery Kwong Wah Hospital

Management of Lower Gastrointestinal Bleeding. Patrick Lau Department of Surgery Kwong Wah Hospital Management of Lower Gastrointestinal Bleeding Patrick Lau Department of Surgery Kwong Wah Hospital Lower Gastrointestinal bleeding The challenge Account for 20% of gastrointestinal bleeding 80% stopped

More information

ORIGINAL INVESTIGATION. Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding

ORIGINAL INVESTIGATION. Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding ORIGINAL INVESTIGATION Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding Lisa L. Strate, MD, MPH; E. John Orav, PhD; Sapna Syngal, MD, MPH Background: Identification of high-risk patients

More information

Clinical Management of Obscure- Overt Gastrointestinal Bleeding. Presented by Dr. 張瀚文

Clinical Management of Obscure- Overt Gastrointestinal Bleeding. Presented by Dr. 張瀚文 Clinical Management of Obscure- Overt Gastrointestinal Bleeding Presented by Dr. 張瀚文 Definition Obscure: : hard to understand; not clear. Overt: : public; not secret. Occult: : hidden from the knowledge

More information

A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?

A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk? Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians

More information

Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY

Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY 15 FEB 2018 Sources Sources Sources Initial evaluation History Physical examination Laboratory evaluation Obtained at

More information

Lower GI bleeding. Aliu Sanni, MD Long Island College Hospital 17 th June, 2010

Lower GI bleeding. Aliu Sanni, MD Long Island College Hospital 17 th June, 2010 Lower GI bleeding Aliu Sanni, MD Long Island College Hospital 17 th June, 2010 Case Presentation CC: Hematochezia HPI: 28yr old male presents with 1 day episode of bloody stools. Denies any abdominal pain.

More information

Acute Upper Gastro Intestinal (UGI) Bleeding

Acute Upper Gastro Intestinal (UGI) Bleeding T Acute Upper Gastro Intestinal (UGI) Bleeding University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies 1. Has there been a GI bleed? There are also UHL trust

More information

On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding

On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year

More information

Low risk upper GI bleeding pathway

Low risk upper GI bleeding pathway Low risk upper GI bleeding pathway Background Low risk upper GI bleeding may be safely managed without an emergency admission to NUH following presentation to the ED. NUH uses the Glasgow Blatchford score

More information

MANAGING GI BLEEDING IN A COMMUNITY HOSPITAL SETTING DR M. F. M. BRULE

MANAGING GI BLEEDING IN A COMMUNITY HOSPITAL SETTING DR M. F. M. BRULE MANAGING GI BLEEDING IN A COMMUNITY HOSPITAL SETTING DR M. F. M. BRULE DISCLOSURES Presenter: Dr Michele Brule Relationships with commercial interests: None OBJECTIVES Assess the severity of GI bleeding

More information

Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage

Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage ORIGINAL ARTICLE Clin Endosc 2015;48:380-384 http://dx.doi.org/10.5946/ce.2015.48.5.380 Print ISSN 2234-2400 On-line ISSN 2234-2443 Open Access Clinical Application of AIMS65 Scores to Predict Outcomes

More information

Early Management of the Patient with Acute GI Bleeding

Early Management of the Patient with Acute GI Bleeding Early Management of the Patient with Acute GI Bleeding Dr Sarah Hearnshaw Consultant Gastroenterologist Newcastle upon Tyne NHS Trust Go through.. Stats Transfusion / resuscitation PPIs When to call us

More information

CrackCast Episode 30 GI Bleeding

CrackCast Episode 30 GI Bleeding CrackCast Episode 30 GI Bleeding Episode overview: 1) List 5 causes of UGIB in adults and pediatrics 2) List 5 causes of LGIB in adults and pediatrics 3) Describe your management approach for severe UGIB

More information

ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding

ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding Lisa L. Strate, MD, MPH, FACG 1 and Ian M. Gralnek, MD, MSHS 2 1 Division of Gastroenterology, University of Washington

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Tran AH, Ngor EWM, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med. Published online August 11, 2014. doi:10.1001/jamainternmed.2014.3746

More information

British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion

British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit

More information

Guidelines for the Management of Upper gastrointestinal bleeding

Guidelines for the Management of Upper gastrointestinal bleeding Guidelines for the Management of Upper gastrointestinal bleeding By Dr. Sinan Butrus F.I.C.M.S Clinical Standards & Guidelines Kurdistan Board For Medical Specialties Upper gastrointestinal bleeding is

More information

Outcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey

Outcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey Bahrain Medical Bulletin, Vol. 29, No. 1, March 2007 Outcome of Upper Gastrointestinal Hemorrhage According to the BLEED Risk Classification: a Two-year Prospective Survey Javad Salimi, MD* Ahmad Salimzadeh,

More information

Gastrointestinal Hemorrhage

Gastrointestinal Hemorrhage Gastrointestinal Hemorrhage Quality Measures Length of Stay RCC Costs per Case Mortality Rate Eligible Readmission Within 30 Days. Critical Event(s) Evaluation Phase/Acute Phase Baseline pain assessment

More information

Lei Gu 1, Fei Xu 2,3 and Jie Yuan 1*

Lei Gu 1, Fei Xu 2,3 and Jie Yuan 1* Gu et al. BMC Gastroenterology (2018) 18:98 https://doi.org/10.1186/s12876-018-0828-5 RESEARCH ARTICLE Open Access Comparison of AIMS65, Glasgow Blatchford and Rockall scoring approaches in predicting

More information

Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit

Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit Video capsule endoscopy as a tool for evaluation of obscure overt gastrointestinal bleeding in the intensive care unit Authors Shahrad Hakimian 1, Salmaan Jawaid 2, Yurima Guilarte-Walker 3, Jomol Mathew

More information

Etiological profile of patients presenting with lower gastrointestinal bleeding at tertiary care hospital at Belagavi: a cross sectional study

Etiological profile of patients presenting with lower gastrointestinal bleeding at tertiary care hospital at Belagavi: a cross sectional study International Journal of Advances in Medicine Badiger RH et al. Int J Adv Med. 2017 Oct;4(5):1429-1433 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20174297

More information

Bleeding in the Digestive Tract

Bleeding in the Digestive Tract Bleeding in the Digestive Tract National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH U.S. Department of Health

More information

Patients on anticoagulant or antiplatelet therapy undergoing elective endoscopic procedures

Patients on anticoagulant or antiplatelet therapy undergoing elective endoscopic procedures This is an official Northern Trust policy and should not be edited in any way Patients on anticoagulant or antiplatelet therapy undergoing elective endoscopic procedures Reference Number: NHSCT/11/454

More information

Juan G Martínez-Cara, Rita Jiménez-Rosales, Margarita Úbeda-Muñoz, Mercedes López de Hierro, Javier de Teresa and Eduardo Redondo-Cerezo.

Juan G Martínez-Cara, Rita Jiménez-Rosales, Margarita Úbeda-Muñoz, Mercedes López de Hierro, Javier de Teresa and Eduardo Redondo-Cerezo. Original Article Comparison of AIMS65, Glasgow Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed

More information

Acute Gastrointestinal Haemorrhage. Dr Reena Sidhu Consultant Gastroenterologist Hon Sen Lecturer University of Sheffield

Acute Gastrointestinal Haemorrhage. Dr Reena Sidhu Consultant Gastroenterologist Hon Sen Lecturer University of Sheffield Acute Gastrointestinal Haemorrhage Dr Reena Sidhu Consultant Gastroenterologist Hon Sen Lecturer University of Sheffield Scope of Talk Introduction Upper GI haemorrhage-non variceal - Pathology/ risk stratification/management

More information

COPYRIGHTED MATERIAL. 1 Approach to the patient with gross gastrointestinal bleeding. Grace H. Elta, Mimi Takami

COPYRIGHTED MATERIAL. 1 Approach to the patient with gross gastrointestinal bleeding. Grace H. Elta, Mimi Takami 1 Approach to the patient with gross gastrointestinal bleeding Grace H. Elta, Mimi Takami Gastrointestinal (GI) bleeding is a common clinical problem that requires more than 300 000 hospitalizations annually

More information

James Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015

James Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015 The Management of Acute Upper Gastrointestinal Bleeding James Irwin Gastroenterology Department Palmerston North Hospital Acute Medicine Meeting Hutt Hospital June 21, 2015 Outline Common Definitions and

More information

Occult GI Bleed. July 2015

Occult GI Bleed. July 2015 Occult GI Bleed July 2015 Occult GI Bleed Occult vs Obscure Occult positive FOB and/or IDA, but no evidence of visible blood loss to pt or physician Obscure GI bleed that persist/ recurs without obvious

More information

Khalid Abusaada, Fnu Asad-ur-Rahman, Vladimir Pech, Umair Majeed, Shengchuan Dai, Xiang Zhu, and Sally A. Litherland

Khalid Abusaada, Fnu Asad-ur-Rahman, Vladimir Pech, Umair Majeed, Shengchuan Dai, Xiang Zhu, and Sally A. Litherland Hindawi Publishing Corporation Advances in Medicine Volume 2016, Article ID 6850754, 6 pages http://dx.doi.org/10.1155/2016/6850754 Research Article Blatchford Score Is Superior to AIMS65 Score in Predicting

More information

Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See

Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See Don t Waste Time with No Chance to See Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See Kathy Bull-Henry, MD, FACG

More information

GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY

GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY Position Statement produced by BSG, AUGIS and ACPGBI GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY Introduction In 2011 the Independent Practice

More information

Gastrointestinal bleeding and life threating conditions in surgery

Gastrointestinal bleeding and life threating conditions in surgery CM w Bydgoszczy UMK w Toruniu Włodzimierz Gniłka Gastrointestinal bleeding and life threating conditions in surgery Gastrointestinal hemorrhage Upper GI hemorrhage proximal to the Treitz ligament (accounts

More information

Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding ABSTRACT

Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Nonvariceal Upper Gastrointestinal Bleeding ABSTRACT 44 Original Article Upper Gastrointestinal Bleeding Score for Differentiating Variceal and Jaroon Chasawat Varayu Prachayakul Supot Pongprasobchai ABSTRACT Background: Upper gastrointestinal bleeding (UGIB)

More information

Lower gastrointestinal bleeding: Spectrum of colonoscopy findings in Ado-Ekiti, Nigeria

Lower gastrointestinal bleeding: Spectrum of colonoscopy findings in Ado-Ekiti, Nigeria Vol. 6(5), pp. 128-133, May 2014 DOI: 10.5897/IJMMS2014.1031 ISSN 2006-9723 Copyright 2014 Author(s) retain the copyright of this article http://www.academicjournals.org/ijmms International Journal of

More information

Laboratory Technique ROLE OF CAPSULE ENDOSCOPY IN OBSCURE GASTROINTESTINAL BLEEDING

Laboratory Technique ROLE OF CAPSULE ENDOSCOPY IN OBSCURE GASTROINTESTINAL BLEEDING Laboratory Technique ROLE OF CAPSULE ENDOSCOPY IN OBSCURE GASTROINTESTINAL BLEEDING J. JAIN* ABSTRACT Capsule endoscopy (CE) is a safe, non invasive technique for evaluation of small bowel (SB) lesions.

More information

Oral anti-thrombotic therapy-management in patients requiring endoscopy

Oral anti-thrombotic therapy-management in patients requiring endoscopy Oral anti-thrombotic therapy-management in patients requiring endoscopy Management of anti-thrombotic therapy in patients requiring endoscopy This guideline suggests appropriate management of patients

More information

Digestive and Liver Disease

Digestive and Liver Disease Digestive and Liver Disease 46 (2014) 313 317 Contents lists available at ScienceDirect Digestive and Liver Disease jou rnal h om epage: www.elsevier.com/locate/dld Alimentary Tract Time trends and outcome

More information

Colonoscopy Explained

Colonoscopy Explained Colonoscopy Explained Your doctor has recommended that you have a medical procedure called a colonoscopy to evaluate or treat your condition. This brochure will help you understand how a colonoscopy can

More information

Frequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema

Frequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema Bahrain Medical Bulletin, Vol.24, No.3, September 2002 Frequency of Diagnosis of Colorectal Cancer with Double Contrast Barium Enema Najeeb S Jamsheer, MD, FRCR* Neelam. Malik, MD, MNAMS** Objective: To

More information

DIVERTICULOSIS MEDICAL AND SURGICAL MANAGEMENT. Simon Radley Consultant Surgeon March 2013

DIVERTICULOSIS MEDICAL AND SURGICAL MANAGEMENT. Simon Radley Consultant Surgeon March 2013 DIVERTICULOSIS MEDICAL AND SURGICAL MANAGEMENT Simon Radley Consultant Surgeon March 2013 Definitions Diverticulosis: presence of diverticulae Diverticular disease: diverticulae associated with symptoms

More information

GASTROINESTINAL BLEEDING. Dr.Ammar I. Abdul-Latif

GASTROINESTINAL BLEEDING. Dr.Ammar I. Abdul-Latif GASTROINESTINAL BLEEDING Dr.Ammar I. Abdul-Latif CLASSIFICATION OF G.I.BLEEDING GIB Appearance Acuity Site Apparent Acute Upper Obscure Chronic Lower UPPER&LOWER G.I.BLEEDING CAUSES OF UPPER G.I. BLEEDING

More information

CHAPTER 30 Gastrointestinal Bleeding

CHAPTER 30 Gastrointestinal Bleeding CHAPTER 30 Gastrointestinal Bleeding Eric Goralnick and David A. Meguerdichian PERSPECTIVE Epidemiology Gastrointestinal bleeding (GIB) accounts for more than 1 million hospitalizations annually in the

More information

Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2

Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2 Original Article Clinical Endoscopic Parameters of Upper Gastrointestinal Bleeding Hemal Shah, 1 T. P. Manohar 2 1 Junior Resident 2 Associate Professor,Department of Medicine, N.K.P. Salve Institute Of

More information

Outcome of Different Diagnostic and Therapeutic Modalities of Acute Lower Gastrointestinal Bleeding; a University Hospital Experience

Outcome of Different Diagnostic and Therapeutic Modalities of Acute Lower Gastrointestinal Bleeding; a University Hospital Experience Outcome of Different Diagnostic and Therapeutic Modalities of Acute Lower Gastrointestinal Bleeding; a University Hospital Experience Yasser El-Naggar, Essam A.Wahab, Afifi F. Afifi, Hasan Abd Alshaqour

More information

Upper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist

Upper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist Upper GI Bleeding HH Tsai MD FRCP FECG Consultant Gastroenterologist Financial Disclosures I have no financial relationship with any manufacturer or supplier of any product mentioned in this talk. GI Audits:

More information

Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds

Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap Simon McPherson, Vascular Interventional Radiologist, Leeds Scale UK 100,000 /year Commonest Vascular IR on-call 75% UGIB 65% NVUGIB

More information

Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy

Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:151 158 Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy SATOSHI SHINOZAKI, HIRONORI YAMAMOTO,

More information

10/1/2018. Case. History. Initial Assessment. Vital Signs. Factors predictive of UGI source. Gastrointestinal Hemorrhage

10/1/2018. Case. History. Initial Assessment. Vital Signs. Factors predictive of UGI source. Gastrointestinal Hemorrhage Case 79 yo M transferred from OSH with blood per rectum Gastrointestinal Hemorrhage Piroska Kopar MD Assistant Professor of Surgery Section of Acute and Critical Care Surgery 4u prbc 2u FFP Mentating,

More information

Epidemiology and Treatment of Colonic Angiodysplasia; a Population-Based Study. Naomi G. Diggs, MD Lisa L. Strate, MD MPH March 2, 2010

Epidemiology and Treatment of Colonic Angiodysplasia; a Population-Based Study. Naomi G. Diggs, MD Lisa L. Strate, MD MPH March 2, 2010 Epidemiology and Treatment of Colonic Angiodysplasia; a Population-Based Study. Naomi G. Diggs, MD Lisa L. Strate, MD MPH March 2, 2010 Background Angiodysplasia is an important cause of occult and acute

More information

ETHIOLOGY OF LOWER GASTROINTESTINAL BLEEDING: A CROSS SECTIONAL STUDY IN IRAN DURING 2013 TO 2015

ETHIOLOGY OF LOWER GASTROINTESTINAL BLEEDING: A CROSS SECTIONAL STUDY IN IRAN DURING 2013 TO 2015 International Journal of Health Medicine and Current Research Vol. 3, Issue 01, pp.744-749, March, 2018 DOI: 10.22301/IJHMCR.2528-3189.744 Article can be accessed online on: http://www.ijhmcr.com ORIGINAL

More information

INVESTIGATIONS OF GASTROINTESTINAL DISEAS

INVESTIGATIONS OF GASTROINTESTINAL DISEAS INVESTIGATIONS OF GASTROINTESTINAL DISEAS Lecture 1 and 2 دز اسماعيل داود فرع الطب كلية طب الموصل Radiological tests of structure (imaging) Plain X-ray: May shows soft tissue outlines like liver, spleen,

More information

Imaging of upper and lower gastrointestinal bleeding: An update for the radiologist

Imaging of upper and lower gastrointestinal bleeding: An update for the radiologist Imaging of upper and lower gastrointestinal bleeding: An update for the radiologist Poster No.: C-3149 Congress: ECR 2010 Type: Educational Exhibit Topic: Vascular Authors: S. Leong, H. Sara, F. Oisin,

More information

Listed below are some of the words that you might come across concerning diseases and conditions of the bowels.

Listed below are some of the words that you might come across concerning diseases and conditions of the bowels. Listed below are some of the words that you might come across concerning diseases and conditions of the bowels. Abscess A localised collection of pus in a cavity that is formed by the decay of diseased

More information

True obscure causes hemobilia, hemosuccus pancreaticus, vasculitis

True obscure causes hemobilia, hemosuccus pancreaticus, vasculitis Endoscopic Techniques for Small Bowel Imaging Going Where No Man Has Gone Before! Jonathan A. Leighton, MD, FACG, FASGE Mayo Clinic in Arizona 2014 ACG Governors/ASGE Best Practices Course January 2014

More information

Colon Cancer Detection by Rendezvous Colonoscopy : Successful Removal of Stuck Colon Capsule by Conventional Colonoscopy

Colon Cancer Detection by Rendezvous Colonoscopy : Successful Removal of Stuck Colon Capsule by Conventional Colonoscopy 19 Colon Cancer Detection by Rendezvous Colonoscopy : Successful Removal of Stuck Colon Capsule by Conventional Colonoscopy István Rácz Márta Jánoki Hussam Saleh Department of Gastroenterology, Petz Aladár

More information

ICU Volume 14 - Issue 2 - Summer Matrix

ICU Volume 14 - Issue 2 - Summer Matrix ICU Volume 14 - Issue 2 - Summer 2014 - Matrix Upper Gastrointestinal Bleeding Authors David Osman, MD Medical Intensive Care Unit Paris-South University Hospitals Assistance Publique-Hôpitaux de Paris

More information

on Anti-coagulants -- Is It Safe? And When to Stop?

on Anti-coagulants -- Is It Safe? And When to Stop? Endoscopy for Your Patient on Anti-coagulants -- Is It Safe? And When to Stop? John R. Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical

More information

Research Article Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding

Research Article Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding Hindawi Radiology Research and Practice Volume 2017, Article ID 1074804, 5 pages https://doi.org/10.1155/2017/1074804 Research Article Super-Selective Mesenteric Embolization Provides Effective Control

More information

When should we operate for recurrent diverticulitis. Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital

When should we operate for recurrent diverticulitis. Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital When should we operate for recurrent diverticulitis Savvas Papagrigoriadis MD MSc FRCS Consultant Colorectal Surgeon King's College Hospital ASCRS Practice parameters for the Treatment of Acute Diverticulitis

More information

Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage

Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage Alimentary Pharmacology and Therapeutics Multicentre comparison of the Glasgow Blatchford and Rockall scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage A. J. Stanley*,

More information

Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology

Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology Faculty representative: David L. Burns, MD, CNSP Resident representative: Tom Castiglione, MD Revision date: March 6, 2006

More information

UGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore

UGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore UGI BLEED Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore Outline UGI bleed: etiology and presentation Management: Non variceal / variceal bleed

More information

Billing Guideline. Subject: Colorectal Cancer Screening Exams (Invasive Procedures) Effective Date: 1/1/14 Last revision effective 4/16

Billing Guideline. Subject: Colorectal Cancer Screening Exams (Invasive Procedures) Effective Date: 1/1/14 Last revision effective 4/16 Billing Guideline Subject: Colorectal Cancer Screening Exams (Invasive Procedures) Effective Date: 1/1/14 Last revision effective 4/16 Florida Hospital Care Advantage plans include full coverage of in-network

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

GI bleeding in chronic liver disease

GI bleeding in chronic liver disease GI bleeding in chronic liver disease Stuart McPherson Consultant Hepatologist Liver Unit, Freeman Hospital, Newcastle upon Tyne and Institute of Cellular Medicine, Newcastle University. Case 54 year old

More information

Quality ID #439: Age Appropriate Screening Colonoscopy National Quality Strategy Domain: Efficiency and Cost Reduction

Quality ID #439: Age Appropriate Screening Colonoscopy National Quality Strategy Domain: Efficiency and Cost Reduction Quality ID #439: Age Appropriate Screening Colonoscopy National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Efficiency DESCRIPTION:

More information

Endoscopic Submucosal Dissection ESD

Endoscopic Submucosal Dissection ESD Endoscopic Submucosal Dissection ESD Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated

More information

Antiplatelets in cardiac patients with suspected GI bleeding

Antiplatelets in cardiac patients with suspected GI bleeding Antiplatelets in cardiac patients with suspected GI bleeding Acute GI bleeding is a common major medical emergency. In the 2007 UK-wide audit, overall mortality of patients admitted with acute GI bleeding

More information

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital Original Article on Endoscopic Therapy Page 1 of 7 Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital Koichiro Kawaguchi,

More information

Polyps in the bowel. Endoscopy Department. Patient information leaflet

Polyps in the bowel. Endoscopy Department. Patient information leaflet Polyps in the bowel Endoscopy Department Patient information leaflet You will only be given this leaflet if you have been diagnosed with polyps in the bowel. The information below outlines the condition,

More information

Article Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children s Hospital Experience

Article Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children s Hospital Experience Article Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children s Hospital Experience Omar Nasher 1, *, David Devadason 2 and Richard J. Stewart 1 1 Department of Paediatric Surgery,

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Gastrointestinal bleeding: the management of acute upper gastrointestinal bleeding 1.1 Short title Acute upper GI bleeding

More information

NCD for Fecal Occult Blood Test

NCD for Fecal Occult Blood Test NCD for Fecal Occult Blood Test Applicable CPT Code(s): 82272 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal

More information

I ron deficiency anaemia (IDA) resulting from gastrointestinal

I ron deficiency anaemia (IDA) resulting from gastrointestinal 405 ORIGINAL ARTICLE Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic s J M Yates, E C M Logan, R M Stewart... See end of article for authors

More information

Anticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula.

Anticoagulants are a contributing factor. Other causes are Mallory-Weiss tears, AV malformations, and malignancy and aorto-enteric fistula. Upper GI Bleeding EMU2018 Dr. Walter Himmel MD Incidence: In non-cirrhotics, the commonest causes are peptic ulcer disease (50%) followed by erosive gastritis. In cirrhotic patients, variceal bleeding

More information

532.6 (chronic or unspecified duodenal

532.6 (chronic or unspecified duodenal Supplementary table 1: ICD-9 and ICD-10 codes used for the identification of major bleeding and endoscopy Bleeding episode type ICD-9 codes ICD-10 codes Intracranial 430 (Subarachnoid), 431 (intracerebral),

More information

Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population

Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population ORIGINAL ARTICLE Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population Henry Tan Chor Lip, MD 1,2, Heah Hsin Tak, MMed Surg 1, Tan Jih Huei,

More information

HCPCS Codes (Alphanumeric, CPT AMA) ICD-9-CM Codes Covered by Medicare Program

HCPCS Codes (Alphanumeric, CPT AMA) ICD-9-CM Codes Covered by Medicare Program HCPCS s (Alphanumeric, CPT AMA) 82272 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening ICD-9-CM

More information

Epidemiology of diverticulosis and diverticular disease. Alfredo Papa U.O.C. Medicina Interna e Gastroenterologia, C.I. Columbus

Epidemiology of diverticulosis and diverticular disease. Alfredo Papa U.O.C. Medicina Interna e Gastroenterologia, C.I. Columbus Epidemiology of diverticulosis and diverticular disease Alfredo Papa U.O.C. Medicina Interna e Gastroenterologia, C.I. Columbus Summary Burden of disease on health care resources (outpatients visits, admissions,

More information

Diagnosis of Severe Acute Lower Gastrointestinal Bleeding With CTA

Diagnosis of Severe Acute Lower Gastrointestinal Bleeding With CTA CASE REPORT Diagnosis of Severe Acute Lower Gastrointestinal Bleeding With CTA Samantha L. Wood, MD; Louis Eubank; Tania D. Strout, PhD, RN, MS A 31-year-old man presented for evaluation of abdominal and

More information

INTRODUCTION TO DIAGNOSTIC ENDOSCOPY

INTRODUCTION TO DIAGNOSTIC ENDOSCOPY INTRODUCTION TO DIAGNOSTIC ENDOSCOPY EGD & Colonoscopy Procedure Kolegium Ilmu Bedah Indonesia B. Parish Budiono Sub Bagian Bedah Digestif FK UNDIP/RSUP Dr. Kariadi Semarang GI Endoscopy GI Endoscopy is

More information

Managing acute upper gastrointestinal bleeding in the acute assessment unit

Managing acute upper gastrointestinal bleeding in the acute assessment unit Clinical Medicine, Vol, No : 589 59 Managing acute upper gastrointestinal bleeding in the acute assessment unit Lotte Dinesen, SpR in gastroenterology; Martin Benson, consultant gastroenterologist and

More information

Estimates of complications and clinically significant findings in screening and surveillance colonoscopy

Estimates of complications and clinically significant findings in screening and surveillance colonoscopy Oregon Health & Science University OHSU Digital Commons Scholar Archive February 2011 Estimates of complications and clinically significant findings in screening and surveillance colonoscopy J. Lucas Williams

More information

Shou Jiang Tang, MD, FASGE. Director of Endoscopic Research Professor in Medicine

Shou Jiang Tang, MD, FASGE. Director of Endoscopic Research Professor in Medicine Shou Jiang Tang, MD, FASGE Director of Endoscopic Research Professor in Medicine Through-the-scope clipping devices Over-the-scope clipping devices First reported clipping device Hayshi T, Yonezawa M,

More information

DIGESTIVE SYSTEM SURGICAL PROCEDURES December 22, 2015 (effective March 1, 2016) INTESTINES (EXCEPT RECTUM) Asst Surg Anae

DIGESTIVE SYSTEM SURGICAL PROCEDURES December 22, 2015 (effective March 1, 2016) INTESTINES (EXCEPT RECTUM) Asst Surg Anae December 22, 2015 (effective March 1, 201) INTESTINES (EXCEPT RECTUM) Z513 Hydrostatic - Pneumatic dilatation of colon stricture(s) through colonoscope... 10.50 Z50 Fulguration of first polyp through colonoscope...

More information

Gastrointestinal haemorrhage

Gastrointestinal haemorrhage Gastrointestinal haemorrhage A common emergency Important cause of mortality and morbidity Case fatality is high (10 20% in the UK) Rockall TA et al. BMJ, 1995. 311(6999): p. 222-6. Williams JG et al.

More information

Policy and Procedure. Title: CAPSULE ENDOSCOPY (CAMERA PILL) Division: Medical Management Department: Utilization Management

Policy and Procedure. Title: CAPSULE ENDOSCOPY (CAMERA PILL) Division: Medical Management Department: Utilization Management Retired Date: Page 1 of 10 1. POLICY DESCRIPTION: Capsule Endoscopy (Camera Pill) 2. RESPONSIBLE PARTIES: Medical Management Administration, Utilization Management, Integrated Care Management, Pharmacy,

More information

SMALL BOWEL GASTROINTESTINAL BLEEDING

SMALL BOWEL GASTROINTESTINAL BLEEDING SMALL BOWEL GASTROINTESTINAL BLEEDING Giovanni DI NARDO giovanni.dinardo@uniroma1.it UOC Gastroenterologia ed Epatologia Pediatrica Dipartimento di Pediatria, Sapienza - Università di Roma (Direttore:

More information

Gastroenterology Tutorial

Gastroenterology Tutorial Gastroenterology Tutorial Gastritis Poorly defined term that refers to inflammation of the stomach. Infection with H. pylori is the most common cause of gastritis. Most patients remain asymptomatic Some

More information

GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint

GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Gastroenterology MOC exam blueprint Based on feedback from physicians that MOC assessments

More information

Gastroenterology. Certification Examination Blueprint. Purpose of the exam

Gastroenterology. Certification Examination Blueprint. Purpose of the exam Gastroenterology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified gastroenterologist

More information

Gastroenterology Fellowship Program

Gastroenterology Fellowship Program Gastroenterology Fellowship Program Outpatient Clinical Rotations I. Overview A. Three Year Continuity Clinic Experience All gastroenterology fellows will be required to have a ½ day continuity clinic

More information

Referral Criteria for Direct Access Outpatient Colonoscopy or Computed Tomography Colonography

Referral Criteria for Direct Access Outpatient Colonoscopy or Computed Tomography Colonography Referral Criteria for Direct Access Outpatient Colonoscopy or Computed Tomography Colonography 2019 Released 2019 health.govt.nz Citation: Ministry of Health. 2019. Referral Criteria for Direct Access

More information

PENNANT HILLS DAY ENDOSCOPY CENTRE 10 RAMSAY ROAD

PENNANT HILLS DAY ENDOSCOPY CENTRE 10 RAMSAY ROAD PENNANT HILLS DAY ENDOSCOPY CENTRE 10 RAMSAY ROAD Licence No. DC 018 PENNANT HILLS, 2120 Provider No. 657211 A www.pennanthillsendoscopy.com.au TELEPHONE: 98752311 FAX: 99809300 Preparation for colonoscopy

More information