Quality statement 4: Endoscopic treatment for non-variceal bleeding

Quality statement

People with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage are offered endoscopic treatments (combination or a mechanical method).

Rationale

Endoscopic treatment of non-variceal acute upper gastrointestinal bleeding can control active bleeding, reduce the rate of re-bleeding and the need for blood transfusion.

Quality measures

Structure

Evidence of local arrangements to ensure that people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage are offered endoscopic treatments (combination or a mechanical method).

Data source: Local data collection.

Process

Proportion of people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage who receive endoscopic treatments (combination or a mechanical method).

Numerator – the number of people in the denominator who receive endoscopic treatments (combination or a mechanical method).

Denominator – the number of people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage.

Data source: Local data collection. Contained in NICE audit support for Acute upper gastrointestinal bleeding: non-variceal (NICE clinical guideline 141). The British Society of Gastroenterology's UK comparative audit of upper gastrointestinal bleeding and the use of blood (2007) asks 'Were any therapeutic endoscopic procedures undertaken?'

Outcome

a) Proportion of people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage who have uncontrolled bleeding or re-bleeding within 48 hours.

Data source: Local data collection.

b) Proportion of people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage who need rescue therapies.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage to be offered endoscopic treatments (combination or a mechanical method).

Healthcare practitioners offer endoscopic treatments (combination or a mechanical method) to people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage.

Commissioners ensure that they commission services that offer endoscopic treatments (combination or a mechanical method) to people with non-variceal acute upper gastrointestinal bleeding and stigmata of recent haemorrhage.

What the quality statement means for patients, service users and carers

People with acute upper gastrointestinal bleeding caused by stomach or duodenal ulcers are offered treatment using an endoscope (a narrow, flexible tube that is swallowed and has a very small camera at its tip).

Source guidance

  • Acute upper gastrointestinal bleeding: management (NICE clinical guideline 141), recommendations 1.4.1 and 1.4.2 (key priorities for implementation).

Definitions of terms used in this quality statement

NICE clinical guideline 141 recommendation 1.4.1 states: do not use adrenaline as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding.

NICE clinical guideline 141 recommendation 1.4.2 recommends using 1 of the following endoscopic treatments:

  • a mechanical method (for example, clips) with or without adrenaline

  • thermal coagulation with adrenaline

  • fibrin or thrombin with adrenaline.

The full guideline Acute upper gastrointestinal bleeding: management concludes that each of these approaches can control active bleeding, reduce the rate of re-bleeding and need for blood transfusion compared with not receiving endoscopic therapy. Trials have failed to show superiority of any single approach.