Background: The number of procedures utilized in the general management of gastrointestinal bleeding (GIB) has not been investigated previously. We used the National Endoscopic Database of the Clinical Outcomes Research Initiative for an observational study to analyze the average length of workup in GIB.
Methods: The electronic database was queried for all patients aged 18 years and older who underwent an endoscopic evaluation for any bleeding indication between 2000 and 2014. Data were stratified by indication, type, and number of endoscopies per patient, and length of workup.
Results: A total of 603 807 endoscopic procedures among 451 470 individual patients were used in the workup of GIB, with 152 337 procedures among 113 030 patients (25%) being performed as a secondary procedure. The average length was 2.4±0.9 procedures per workup in procedural sequences involving multiple endoscopies. The length of workup was independent of the initial type of GIB. An esophago-gastro-duodenoscopy (EGD), followed by a colonoscopy or a colonoscopy, followed by an EGD were the most frequent combinations. In another substantial fraction of two consecutive procedures, the first and the second procedure were identical. This pattern applied not only to EGD and colonoscopy but also to flexible sigmoidoscopy, enteroscopy, and video capsule endoscopy.
Conclusion: The majority of patients with GIB require only one type of endoscopy to manage their bleeding. However, in a quarter of patients, on average, 2.4 procedures are needed. Previous trials assessing the outcomes of individual types of endoscopy may have exaggerated their overall success rates in diagnosing and treating GIB.