BSPGHAN 2021 Virtual Annual Meeting

27- 29 April 2021

EMERGENCI: A UK PROSPECTIVE SURVEY OF SEVERE GI BLEEDING (REQUIRING UPPER GI ENDOSCOPY) AND EMERGENCY ENDOSCOPY IN UNDER 16S

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Christine Spray
Christine Spray
22 days ago

Thank you for your poster. This is interesting data. In those who had oesophageal varices and treated all transferred to liver units for treatment and known to have underlying liver disease? How many days did they wait for transfer? What were the co – morbidities? What was the difference between the units and operators of endoscopy, when patients were transferred and those where patients were not transferred?

Natasha Thorn
Natasha Thorn
19 days ago

Dear Christine,

Many thanks for your interest and your questions on our poster.

Of the 8 cases of Oesophageal varices reported in the 6 month period and requiring emergency OGD, 6 were treated at Paediatric Liver Centres, and 2 at non-specialist liver centres. 6 were transferred from another hospital before their OGD and 2 were not.

All had underlying pre-existing hepatic co-morbidities. 2 cases were likely in the same patient but cannot confirm due to anonymised data.

The endoscopists of the 8 cases were 5x GHN consultants (4 at specialist liver centres, 1 at a non-liver centre) 2x Paediatric Surgeons at another liver centre and 1x Adult Endoscopist Consultant at a non-specialist paeds liver centre.

Median transfer time for the 6 cases transferred was 2.7 days, ranging from 6.5hrs to 4.5 days.

1 patient (transferred from an international hospital in the middle east to a paediatric liver centre) died of multi-organ failure with end stage cirrhosis.

I hope this answers all your questions and again thank you for your interest! This project resulted in lots of interesting data and we are planning to present it as a full paper over the coming months.

Many thanks
Natasha

David Campbell
David Campbell
18 days ago

Thank you and well done, this is very helpful data.
Do you see a risk with how this data can be used if not balanced.
To say 56% of centres had no severe UGIB in 6 months might imply no requirement for an interventional service due to scarcity of events. How does that compare to other rare life threatening events that we resource our services to deal with as required?
I would appreciate the balance in conclusions more along the lines of “So what? Now what?”, after the conclusion of “what we have seen”.
This is important and there is a risk that others, less balanced in their views might do this on our behalf.
I know that there is more to come along those lines but it would help the society to have your considerations and reflections along side the observations.
Thank you.

Nick Croft
Nick Croft
18 days ago
Reply to  David Campbell

Thanks David. You make an important point, as you can see the poster is really reporting the data and this is intended to help BSPGHAN, NHS and Centres to define the best options for the service. It is not intended to say no 24 hour interventional service is required just suggests this cannot realistically be provided in every centre. We are preparing a paper where points you make will be addressed. In my mind options are stabilising and transferring them to other centres (our data suggest this seems to be a safe option), creative collaborations between nearby centres for regional rotas (of those with the skills required) or working with adult colleagues for the technical input of interventions. Thanks again Nick