730 Current Management of Acute Lower Gastrointestinal Bleeding: Experience from a District General Hospital

Abstract Aim To evaluate current practice at a District General Hospital for the management of patients with lower gastrointestinal bleed (LGIB) in the context of the 2019 British Society of Gastroenterology (BSG) guidelines. Method Consecutive patients presenting with acute LGIB over an 8-month period in 2022 were identified from a prospectively-maintained repository. Exclusion criteria included upper gastrointestinal bleeds, ambulatory patients and LGIB whilst already inpatients. A retrospective case note review was conducted using hospital IT systems and patient notes. Patients were categorised as “major” or “minor” bleeds, as per the BSG treatment algorithm. Data was extracted on demographics, investigation, and management of LGIB and compared with the guideline recommendations. Results 48 patients were included in this study: 25 males and 23 females. Median age was 75 years (range 34-98). 42 patients had a major bleed, of which 17 underwent flexible sigmoidoscopy (40%), three performed as an inpatient. Eight patients underwent colonoscopy (19%), with one performed as an inpatient. Of seven patients who received blood products, five were in line with recommended blood transfusion triggers (71%). Of 14 patients admitted on either warfarin or a direct oral anticoagulant, 12 were appropriately suspended on admission (85%). Conclusions We demonstrate adherence to a number of the recommendations of the BSG guidelines for LGIB. At our unit there was a preference for outpatient sigmoidoscopy for stable patients rather than inpatient colonoscopy as recommended in the guideline. This may reflect a weak level of evidence in support of this recommendation.