A prospective comparative trial between early endoscopy and radiology in acute upper gastrointestinal haemorrhage.

Abstract

SUMMARY A prospective comparative trial is reported between the results of early endoscopy and barium meal examinations in 150 patients admitted with acute upper gastrointestinal haemorrhage. One hundred and thirty-eight patients underwent both investigations within 24 hours of admission. Emergency endoscopy accurately identified the source of haemorrhage in 86% of patients and emergency radiology identified the source in 51 %. Misleading positive reports were given endoscopically in 3 % and by barium meal in 8 %. The identification of the source of haemorrhage was possible in 126 patients (91 %) by the use of both methods. Emergency endoscopy is shown to be superior to emergency barium meal examination, but the examinations are complementary and both should be used for these patients.

Transcatheter arterial embolization in gastric cancer patients with acute bleeding

“…The use of endoscopy may lead to gastric cancer becoming a more commonly recognized cause of gastric bleeding [5]. The reported incidence of gastric bleeding associated with gastric cancer ranges from 1 to 8% [5][6][7][8][9][10]. As a first line to achieve hemostasis, therapeutic endoscopy has been used for gastric cancer bleeding [11][12][13]; however, endoscopic bleeding control is difficult when bleeding is massive or diffuse [8].…”

Acute upper gastrointestinal bleeding as primary symptom of gastric carcinoma

“…Hematemesis was the presenting symptom in 36 of our patients with gastric carcinoma; this figure represents 4.8% of all early upper GI endoscopies due to acute GI bleeding. This frequency has remained constant in our series [8], and correlates with those of other Spanish authors [9-111, but it is higher than those obtained in countries with a different epidemiology of gastric cancer [ 1,[3][4][5][6][7]201. The elevated frequency (4.4%) obtained by Hoare [21] may be due to the fact that his series included 21.5% of patients who presented melena alone, reflecting a more chronic than acute hemorrhage.…”

A Primer

“…The literature is very mixed on the timing of subspecialty consultations and interventions in such common ICU conditions as stroke and gastrointestinal bleeding, as critical care and emergency providers often can serve as the first line to triage, care for, and selectively initiate appropriate subspecialty involvement. 11,[84][85][86][87][88][89][90][91][92][93] Still, in several conditions such as TIA and stroke, management in specialty units was associated with improved outcomes. 94,95 Nevertheless, many confounders underlying the bed allocation process may account for differential ICU outcomes by nominal specialty.…”