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Southern Medical Journal:
doi: 10.1097/01.SMJ.0000149389.24871.C1
Original Article

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

Kethu, Sripathi R. MD; Davis, Geoffrey C. MD; Reinert, Steven E. MS; Ramzan, Usman C. MD; Moss, Steven F. MD

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Abstract

Objectives: To determine the clinical utility of upper endoscopy in patients who have upper gastrointestinal bleeding after hospitalization.

Methods: Patients were studied who underwent upper endoscopy for an indication of suspected upper gastrointestinal bleeding that developed more than 48 hours after hospitalization. Demographic, clinical, and endoscopic data were extracted by chart review. Bleeding was characterized as clinically important (defined as overt bleeding in association with hemodynamic compromise or the need for blood transfusion) or non-clinically important.

Results: Eighty-six patients met inclusion criteria. Clinically important bleeding occurred in 17%. Peptic ulcer disease and gastritis were the most common sources of bleeding in the clinically important and non-clinically important groups, respectively. The bleeding source was not found in 24% of patients. Endoscopic therapy was required in 11% (all of whom had clinically important bleeding). Upper endoscopy prompted no treatment changes in the non-clinically important bleeding group.

Conclusions: 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.

Key Points

* Upper gastrointestinal bleeding that develops in hospitalized patients can be categorized into clinically important and non–clinically important bleeding.

* Endoscopy in patients who have non–clinically important bleeding does not change the overall treatment of the patient.

* A conservative approach can be recommended in patients who have non–clinically important upper gastrointestinal bleeding that will avoid many unnecessary endoscopic procedures.

© 2005 Southern Medical Association

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