Clinical practice patterns in the pre-endoscopic management of individuals presenting with acute upper gastrointestinal bleeding: results of an international survey.

Background: Despite recent guideline recommendations on managing acute upper gastrointestinal bleeding (AUGIB), mortality rates have not substantially improved over the years. Objectives: We aimed to understand real-life pre-endoscopic assessment and management practices in AUGIB. Design: We conducted an international online survey from April to November 2023. Methods: Key domains captured respondents' demographics and clinical practice location, definitions of hemodynamic instability, and pre-endoscopic assessment. We provided descriptive proportions of responses. Secondary analyses explored differences in responses based on years of clinical experience. Results: Among the 533 clinicians who completed the survey, 47.1% reported using a triage system for AUGIB, and only 60.4% applied risk stratification scores at the time of presentation. Normal saline and balanced crystalloid fluids were almost equally preferred for initial fluid resuscitation. Hemodynamically unstable patients were typically managed in emergency departments and/or intensive care units. Over 85% of respondents followed a restrictive blood transfusion strategy in stable patients, but this dropped to 50.3% in hemodynamically unstable cases. Among respondents, 34.3% did not routinely use prokinetics, and 27.6% avoided their use, even in cases of severe bleeding or suspected gastric emptying disorders. The majority (87.1%) prescribed proton pump inhibitors before endoscopy. For suspected variceal bleeding, 83.7% reported using vasoactive agents, and 74.3% reported administering prophylactic antibiotics. Younger clinicians were more likely to follow recent guidelines than those with over 15 years of clinical experience. Conclusion: We found considerable variation in the pre-endoscopic management of individuals with AUGIB. Overall adherence to international guidelines was inconsistent, which may have implications for patient outcomes.