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Biography

Anil Gandhi joined Monash University in August 2009 as a Clinical Associate Professor (Surgery). Dr Gandhi graduated from Christian Medical College, India in 1980 and obtained his Master in Surgery from the renowned Post-Graduate Institute of Medical Education & Research, Chandigarh, India. After post-graduation, Dr Gandhi worked in various hospitals in India and South -East Asia namely Brunei, Singapore, Malaysia and Hong Kong. He specializes in the field of Endoscopy, laparoscopy and upper GI Surgery. For the last few years, Dr Gandhi has developed a keen interest in Medical Education. Before joining Monash University, Dr Gandhi was working at Queen Mary Hospital, University of Hong Kong and was Deputy Director at the centre for Education & Training within the Dept of Surgery. He has worked extensively in the field of clinical & surgical skills lab and was a vital contributor in setting up skills centers in his previous places of work. His current plan is setting up a Skills centre on-line apart from clinical interest in Endoscopy and Upper GI Surgery

Abstract

Most patients who present with gastrointestinal bleeding have stopped bleeding when they arrive in hospital. Although it is standard practice for those who exhibit homodynamic instability or features of continued bleeding to undergo emergency endoscopy with view to endoscopic arrest of bleeding, the proportion of patients who require this has not been widely addressed. Aim A study was undertaken to determine (i) The proportion of patients undergoing emergency endoscopy (after initial resuscitation) and (ii) The proportion of patients undergoing semi urgent endoscopy (within 24 hours of presentation) who were found to have bleeding lesions which required endoscopic intervention to arrest haemorrhage Methods DESIGN: Database Review SETTING: Tertiary Centre Surgical Gastrointestinal Unit PERIOD: One year INCLUDIONS: All patients undergoing emergency and semi urgent (within 24 hrs) diagnostic and/or therapeutic endoscopy. EXCLUSION: Patients undergoing subsequent endoscopic procedures for repeat diagnostic or therapeutic procedures EMERGENCY ENDOSCOPY: Patients with tachycardia, hypotension and/or evidence of continued bleeding e.g. haemetemesis while in hospital were resuscitated and then underwent emergency endoscopy. SEMIURGENT ENDOSCOPY: Patients who did not have tachycardia or hypotension underwent endoscopy in the next available endoscopy session within 24 hours. Results 7 out of 46 (15%) patients were found to have active bleeding on upper endoscopy.All the 7 (24%) patients belonged to the emergency group who were scoped immediately after resuscitation, while in the semi-urgent group none was found to have active bleeding when they were scoped within 24 hours after presentation to A & E.2 (7%) patients in emergency and 5(29%) patients in the semi-urgent group had stigmata of recent haemorrhage on endoscopy. The bleeding could have stopped in the interval between resuscitation and emergency endoscopy. Conclusion All patients with symptoms of upper GI bleeding do not require endoscopy immediately on arrival to the hospital as only 15% were found to be having active bleeding. Although the bleeding may have ceased in the interval between resuscitation and emergency endoscopy, this relatively large proportion may reflect the comfortable safety margin of the selection criteria for emergency endoscopy, it may have implications on on-call emergency staffing

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