Low Utility of Endoscopy for Suspected Upper Gastrointestinal Bleeding Occurring in Hospitalized Patients

Abstract

Endoscopic therapy was needed only in the few patients with clinically important bleeding. Nonendoscopic treatment can be recommended for upper gastrointestinal bleeding developing in hospitalized patients who do not meet established criteria for a clinically important bleed.

Primary and Secondary Nonvariceal Upper Gastrointestinal Bleeding

“…5 In hospitalized patients with noncritical bleeding, the episodes are usually self-limited and can be managed with supportive acid-suppressive medication rather than endoscopic intervention. 5,8,15 It is true that in our series 25% of the primary bleeders did not undergo an upper endoscopy. The main reason for not scoping these subjects is that the bleeding was minor and ceased spontaneously or their refusal.…”

“…6,7 By contrast, endoscopic therapy is rarely needed in secondary bleeding. 8 Several studies have identified the prognostic factors for successful endoscopic therapy. 3,4,[9][10][11] The aim of the present study was to characterize and compare the clinical pictures of primary and secondary UGI bleeding in a tertiary academic center.…”

Upper gastro-intestinal bleeding in Erbil Governorate

“…No source of bleeding was found in 7 patients (14%), both at endoscopy and surgery, while in other series it was 24% (21,22) . Recently different treatment modalities were studied like injection of clot induced factor, a combination of injection and thermal therapies, and the use of mechanical devices such as clips, ligature.…”

Upper Endoscopy in Patients with Acute Myocardial Infarction and Upper Gastrointestinal Bleeding: Results of a Decision Analysis

“…Lesions other than peptic ulcers, such as gastritis and esophagitis, may result in UGIB and, in fact, may be the predominant EGD finding in hospitalized patients with UGIB episodes not associated with hemodynamic changes or transfusion requirement [30]. Given their diffuse nature, such lesions, typically, are not amenable to endoscopic therapy.…”

“…Our model assumed that patients with fecal occult blood could be found to have peptic ulcers on EGD—limited data reporting the frequency of documented peptic ulcer disease in hospitalized patients with occult or clinically insignificant blood loss present a wide range of estimates, from 1% [30] to greater than 20% [39]. Even among patients with fecal occult blood and a plausible bleeding source identified on EGD, no large-scale prospective or retrospective data exist to suggest what percentage of these patients will require specific endoscopic therapy.…”