1. Am J Gastroenterol 2012; 107:405–410 Fellow : Kim Jung Wook

2. Introduction Upper gastrointestinal bleeding (UGIB)   Annual incidence : 160/100,000 (US)   Overall mortality : 5~10% Endoscopy   Diagnosis (etiology, source of bleeding),   Treatment (hemostasis)   Prognostic information (risk of rebleeding)   Most national / international guideline → within 24h of presentation in patients with UGIB   Early endoscopy → need for hospitalization ↓

3. Introduction “Weekend effect”   Hospital admission for UGIB over weekends a/w increased mortality   Nationwide Inpatient Sample database from US Patient Episode Database for Wales from UK → mortality 8~21% ↑ In Hong Kong, UGIB registry (prospective cohort)   mortality rate of peptic ulcer bleeding(PUB) : ~6.2%   majority of PUB : non-bleeding related   emergency endoscopy service

4. Introduction The aims of this study   Mortality among patients with PUB (holiday vs weekday)   Rick factors a/w mortality of PUB

5. Methods Study population   UGIB registry in the Prince of Wales Hospital   Admitted for Sx and signs of UGIB   Prospectively collected from 1993 to 2005   Patient outcomes within 30 days after discharge Data extraction   Location of bleeding lesions, stigmata of recent hemorrhage   use of drugs (H2 blocker, PPI, NSAID, antiplatelet agent)   Serious comorbid illness   Hemodynamic parameters   The time of admission (Sunday and public holiday vs weekday)   Waiting time for endoscopy (within 12 or 24h vs beyond 1 day)

6. Methods Outcomes   Primary endpoint : 30-day mortality   All-cause of mortality within 30 days of admission to hospital   Cause of death 1. bleeding-related death - uncontrolled bleeding - death within 48h after endoscopy without other cause identified - death during surgery for uncontrolled bleeding - death related to surgical complications within 1M after surgery - death related to endoscopic procedures 2. non-bleeding related death

7. 19.1% 80.9%

14. Conclusion When therapeutic endoscopy can be offered within 1 day after admission for PUB, holiday admission will not adversely affect bleeding mortality

21. Apr 2010 - Mar 2011 Patients Number of discharges A verage days of stay for inpatients 129,774 4.9 Accident & Emergency D epartment First attendance150,638 Specialist outpatient serv ice Clinical services total at tendance Allied health s ervices total attendance 677,028 165,094