Establishing a dedicated gastrointestinal bleeding centre in Chennai: Proceedings of a multidisciplinary panel conference and an evidence-aligned implementation framework with a prospective registry proforma
Keywords:
GI bleeding, Endoscopy, CT angiography, Embolization, Variceal hemorrhage, TIPS, Bleed unit, Quality improvement registryAbstract
Background: Acute GI bleeding requires time-critical recognition, resuscitation, and rapid access to endoscopic and/or radiologic hemostasis. Variation in pathway execution contributes to avoidable transfusion, delayed definitive therapy, rebleeding, and mortality.
Objective: To summarize the proceedings of a Chennai panel conference convened as a prelude to launching a dedicated GI Bleed Centre, and to present an evidencealigned implementation framework including a prospective data collection proforma for 12-month local benchmarking.
Methods: Structured meeting report with narrative evidence synthesis. Conference themes were mapped to clinical questions across five domains (front-door recognition/triage; endoscopy pathway; Intervention Radiology/surgery escalation; variceal bleeding; lower GI bleeding and systems design). Evidence mapping prioritized high-authority guidance and landmark trials, including American College of Gastroenterology- Upper Gi Bleed guideline(ACG-UGIB) (2021) , European Society Of Gastrointestinal Endoscopy- Nonvariceal Upper Gastrointestinal Bleeding(ESGENVUGIH) guideline (2021) , ESGE Lower GI Bleed guideline (2021) , American Association For the Study Of Liver Disease(AASLD) portal hypertension/varices practice guidance (2024) and Baveno VII consensus (2022).
Results: Proceedings emphasized a “physiology-first, pathway-driven” model: (i) Use risk scores primarily to identify very-low-risk discharge candidates; (ii) Apply restrictive transfusion as default; (iii) Perform early endoscopy within 24 hours after stabilization for non-variceal UGIB; (iv) Integrate CT- Angiography-to-Intervention Radiology pathways for brisk bleeding; (v) Treat variceal bleeding as “double disease” requiring immediate vasoactive agents and antibiotics, and defined triggers for early Transjugular Intrahepatic Portosystemic Shunt(TIPS) in selected high-risk patients. A prospective registry proforma is provided to measure door-to-therapy times, bundle adherence, complications, rebleeding, and mortality.
Conclusion: A dedicated GI Bleed Centre can be operationalized through single-call activation, standardized checklists, 24/7 hemostasis capability and Key Performance Indicators (KPI)-driven audit, supported by prospective local data capture.
