Clinical and endoscopic profile of GI bleed patients at 1win (KCN): A clinical audit

Arivarasan. K

Consultant Medical Gastroenterologist and Hepatologist, 1win, Cantonment, Trichy

Materials and Methodology

The medical records of all consecutive patients admitted to the Kauvery hospital, Cantonment under the department of Medical Gastroenterology, with a diagnosis of acute GI bleed, from 1^st January 2023 to 31^st January 2025 were reviewed

Patients’ demographics and other variables were recorded
Etiology, final outcome and interventions done were recorded.
We assessed the use of blood products in the management of GI bleed

Study Design

This is a 2 years’ retrospective study, done at kauvery hospital, cantonment, from January 2023 to January 2025.

Inclusion criteria

All patients with acute GI bleed admitted under the Medical Gastroenterology department were included

Exclusion criteria

Patients who were admitted with GI bleed under other departments were excluded

Patients who were admitted for another condition and had bleed during hospital stay were excluded.

Results

A total of 178 patients with a diagnosis of GI bleed as recorded in EMR database were identified

1. Demographics

Mean age – 57

Range – 12- 97 yrs

Site of origin of bleed

2. Type of Bleed

Localisation of bleed by a presentation

Upper GI bleed

Hematemesis
Melena

Lower GI bleed

Maroon coloured stool
Hematochezia

Clinical Presentation

Hematemesis	57 (32%)
Melena	52 (29%)
Hematemesis and Malena	57 (32%)
Hematochezia	12 (7%)

*2 patients with hematochezia had UGI bleed

*6 patients with melena had LGI bleed

Endoscopy

UGI scopy – 168 pts
LGI scopy – 22 pts
Not done in 2 patients due to poor hemodynamic status

Discussion

Variceal vs Non-Variceal bleed

Non Variceal	Variceal
• Abdominal pain • h/o retching • h/o NSAIDS/aspirin • Past h/o peptic ulcer disease • GERD symptom	• Stigmata of liver disease • Splenomegaly • Alcoholism

Differential Diagnosis – Upper GIB

UGI bleed

Variceal bleed N = 88 (55%)	Non variceal bleed N = 72 (45%)
• Esophageal varices – 68 • Gastric varices – 18 • Duodenal varices – 1 • Post EVL ulcer – 1	• Duodenal ulcer – 17 • Gastric and duodenal erosions – 17 • Esophagitis – 13 • Mallory Weiss tear – 9 • Gastric ulcer – 8 • Cameron ulcer – 2 • Ca Esophagus – 1 • Splenic artery aneurysm – 1 • Post corrosive injury – 1 • Esophageal submucosal hematoma - 1 • Diffuse mucosal bleed - 1 • Dental bleed - 1

Differential Diagnosis – Lower GIB

Diverticulosis (up to 42%)
Ischemia (up to 18%)
Hemorrhoids, fissures (up to 16%)
UGI or small bowel bleed (up to 13%)
Neoplasia (up to 11%)
Other (IBD, infectious colitis, post-polypectomy)
Unknown cause in up to 23% of cases

LGI bleed

Diverticular bleed – 7
Colonic telangiectasia – 2
Stercoral ulcer – 2
Angiodysplasia – 2
Ca sigmoid – 1
Caecal ulcer – 1
Ileal ulcer – 1
GIST – 1
Colonic nodule – 1
Hemorrhoids – 1

Therapeutic interventions

Non-Variceal Bleed	Non thermal methods
• Argon plasma coagulation • Monopolar coagulation • Bipolar coagulation • Heater probe coagulation • Laser coagulation	• Injection method • Clips • Hemospray

*Initial hemostasis achieved more than 90%.

Variceal Bleed

Esophageal varices	Gastric and ectopic varices
• Variceal banding • Sclerotherapy • Self-expanding metal stents	• Glue injection • EUS guided coiling • Balloon retrograde transvenous obileteration (BRTO)

Anticoagulants/Antiplatelet

Anti-coagulant – 8
Anti-platelet – 37

Transfusion protocols

1. Anticipate need for blood transfusion

Threshold should be based on underlying condition, hemodynamic status, markers of tissue hypoxia
Should be administered if Hb ≤ 7 g/dL
Remember that initial Hct can be misleading

2. Correct coagulopathy (do not attempt to correct coagulopathy in cirrhosis patients)

3. FFP/PRP (INR>1.5, PLT<50).

Transfusions

No of patients	Type of blood products	Used number of blood products
6	FFP	16	• 5 CLD patients • 1 Patient on acitrom
5	Platelet	35
120	PRBC	35	• For 55 patients >2 PRBC required. • 65 Patients required <2PRBC • 12 PRBC used in single patient.

For 23 patients PRBC was given when Hb more than/equal to 8g/dL.

Baseline Hb	No of patients
16	1
12	1
11	1
10	4
9	4
8	12

Duration of stay and outcomes

Mean duration of stay – 4 day
Maximum duration of stay – 22 days

Outcome

Alive – 169
Death – 9 (5.6%)
AMA discharge – 12

Only 1 patient among AMA patients had failure of bleed control

Cause of death

S. No	COD
1	Massive UGI bleed/Hemorrhagic shock - CLD
2	ACLF/Massive UGI bleed/Bleeding diathesis
3	Type II Respiratory failure/Septic shock - CLD
4	Massive GI bleed/DIC - CLD
5	Massive GI bleed/Refractory shock - CLD
6	DIC/Persistent hyperkalemia - CLD
7	Massive GI bleed/Severe metabolic & lactic acidosis - CLD
8	Hypovolemic shock/Severe metabolic & lactic acidosis - CLD
9	ACLF/Persistent hyperkalemia/HE Grade IV - CLD

Conclusion

Variceal bleeding is the most common cause of upper GI bleeding
Colonic diverticulosis is the most common cause of lower GI bleeding
Mortality in our study group was 5.6%, No statistically significant difference was noted among outcome groups
Scope of improvement in optimization of blood products needed.

Acknowledgment

Department of transfusion medicine
Department of anaesthesiology
Department of emergency medicine
Department of critical care
Department of radiology
Department of gastrosurgery
Department of Nursing.

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Applied Medical Statistics

Clinical and endoscopic profile of GI bleed patients at 1win (KCN): A clinical audit