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A Randomized Controlled Trial of Gastric Lavage Prior to Endoscopy for Acute Upper Gastrointestinal Bleeding

Lee, Scott D., MD*; Kearney, David J., MD

Journal of Clinical Gastroenterology: November-December 2004 - Volume 38 - Issue 10 - p 861-865
Alimentary Tract: Clinical Research
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Goals: We hypothesized that large volume gastric lavage prior to endoscopy for acute upper gastrointestinal bleeding would improve the quality of endoscopic examination.

Background: Blood retained in the stomach can impair visualization during esophagogastroduodenoscopy. Patients with acute upper gastrointestinal bleeding and a retained gastric fundic pool during endoscopy may have worse outcomes than patients without a retained fundic pool. No trials to date have evaluated if large volume gastric lavage prior to endoscopy improves visualization during acute upper gastrointestinal bleeding.

Study Methods: Patients with acute upper gastrointestinal bleeding were randomized to esophagogastroduodenoscopy alone or large volume tap water gastric lavage prior to esophagogastroduodenoscopy. The quality of endoscopic visualization was assessed using a 5-point scale. Clinical outcomes were compared for lavaged and nonlavaged patients.

Results: A total of 39 patients were randomized. In 1 patient, lavage was unsuccessful. The quality of visualization was not significantly different between groups for the esophagus, gastric antrum, or duodenum but was significantly better for the gastric fundus for patients randomized to lavage (P = 0.02). There was no significant difference between groups for ability to define a bleeding source, achieve hemostasis, recurrent bleeding, need for repeat endoscopy, and length of stay or death. There were no complications.

Conclusions: Large volume gastric lavage prior to esophagogastroduodenoscopy for acute upper gastrointestinal bleeding is safe and provides better visualization of the gastric fundus.

From the *University of Washington School of Medicine, Gastroenterology Section, and the †VA Puget Sound Health Care System, Seattle, WA.

Received for publication August 20, 2002; accepted June 14, 2004.

Presented at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 22, 2001, Atlanta, GA (Gastrointestinal Endoscopy 53, AB67).

Supported by a grant from the Pacific Northwest Gastroenterology Society.

Reprints: Scott D. Lee, MD, University of Washington Medical Center, Division of Gastroenterology, 1959 NE Pacific Ave, Box 356424, Seattle, WA 98195 (e-mail: leesd@u.washington.edu).

© 2004 Lippincott Williams & Wilkins, Inc.