Mulholland, G.; Forrest, J.A.H.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA26
Academic Journal
Introduction and Aim: Acute upper Gl bleeding (UGIB) accounts for approximately 8% of acute medical admissions and such patients are routinely admitted for observation and diagnostic endoscopy. This study aimed to assess the safety and outcome of rapid access outpatient endoscopy for patients presenting with minor upper Gl bleeding (Rockall score zero). Study Design: Over a 3 year period patients presenting with UGIB who had a pre-endoscopy Rockall score of zero were identified in A&E.They were discharged home with an appointment for an OP endoscopy. Results: 64 patients were referred from A&E; 42 M and 21 F, mean age 37.8 (range 19-79). 42 endoscopies were performed, there being 20 DNAs and 2 inappropriate referrals (vomiting alone). 51 patients presented with haematemesis, 4 with melaena, and 7 with both. 8 patients had taken aspirin or an NSAID and 24 excess alcohol. Of the 20 DNAs 14 had misused alcohol. At endoscopy 14 patients had oesophagitis, 8 a peptic ulcer, 4 gastritis, 4 duodenitis, and 1 oesophageal varicies. 7 patients had dual pathology and 18 had a normal endoscopy. H pylori was positive in 16 of 34 patients tested. Average Hb (n = 24) was 14.3 (range 11.3-16.8). Average interval between presentation and endoscopy was 14 days (range 1-77). No patient had recurrennt bleeding. Conclusion: The study showed it to be safe practice to discharge patients from A&E with minor UGIB and a pre endoscopy Rockall score of zero and to perform an OP endoscopy. The high DNA rate (31%) reflected the significant number of patients who misused alcohol. 57% of those attending for endoscopy had significant pathology; oesophagitis being the most common abnormality. The number of A&E referrals with UGIB for OP endoscopy was significantly less than expected; probably because SHOs were unhappy to discharge such patients home.


Related Articles

  • Diagnostic Yield and Impact of Capsule Endoscopy on Management of Patients with Gastrointestinal Bleeding of Obscure Origin. Eduardo Redondo-Cerezo; Gracia Pérez-Vigara; Angel Pérez-Sola; Carmen Gómez-Ruiz; Miriam Chicano; Natividad Sánchez-Manjavacas; Julia Morillas; José Pérez-García; Jesús García-Cano // Digestive Diseases & Sciences;May2007, Vol. 52 Issue 5, p1376 

    Abstract  This study assessed diagnostic yield and impact of capsule endoscopy on patient management. Seventy-five patients with obscure gastrointestinal bleeding were included. Clinical and followup information was collected by review of patient records and with personal contact with the...

  • State of the Art. Papp, John P. // American Journal of Gastroenterology;May1979, Vol. 71 Issue 5, p516 

    Emergency endoscopy to find the site of upper gastrointestinal bleeding is now accepted as the diagnostic method of choice. Endoscopic electrocoagulation in uncontrolled series has been successful in 98% of patients so treated (142 of 147). If a vessel is seen in an ulcer bed, shine preliminary...

  • Predictors of Variceal Cause of Upper Gastrointestinal Tract Hemorrhage. Lertsithichai, Panuwat; Tangkittimasak, Suwat; Sumritpradit, Preeda // Thai Journal of Surgery;Jan-Mar2005, Vol. 26 Issue 1, p1 

    Objective: To identify significant pre-endoscopic predictors of variceal cause in patients with acute upper gastrointestinal tract (GI) hemorrhage. Patients and Method: Medical records of 187 patients with primary diagnosis of upper GI hemorrhage treated during the period from May 2003 to July...

  • Anorectal Dieulafoy's lesion. Gupta, Ajay; Chabbra, Mohnish // Indian Journal of Surgery;Dec2006, Vol. 68 Issue 6, p325 

    Dieulafoy's lesion is a rare but well-recognized cause of life-threatening bleeding from the gastrointestinal tract, especially upper gastrointestinal tract, resulting due to rupture of an exposed submucous artery. With the advances in endoscopy and awareness of Dieulafoy's lesion as the cause...

  • The role of laparoscopy in the diagnosis of intestinal vascular anomalies affecting two small infants. Alberti, Daniele; Borsellino, Alessandro; Cheli, Maurizio; Sonzogni, Aurelio; Brena, Mario; Locatelli, Giuseppe; Brena, Mario Leo // Pediatric Surgery International;Apr2005, Vol. 21 Issue 4, p301 

    Two infants affected by intestinal vascular anomalies causing lower gastrointestinal hemorrhage are reported. Upper and lower gastrointestinal tract endoscopy and radionuclide scan were negative. The authors found laparoscopic exploration very useful in detecting the cause and the site of...

  • A comparison of the results of arterial embolization for bleeding and non-bleeding gastroduodenal ulcers. Loffroy, Romaric; Lin, MingDe; Thompson, Carol; Harsha, Amith; Rao, Pramod // Acta Radiologica;Dec2011, Vol. 52 Issue 10, p1076 

    Although some authors have advocated the practice of arterial embolization for angiographically negative acute hemorrhage from gastroduodenal ulcers, this technique remains controversial. Purpose: To compare the results of arterial embolization for bleeding (BU) and non-bleeding (NBU)...

  • Early Intensive Resuscitation of Patients With Upper Gastrointestinal Bleeding Decreases Mortality. Baradarian, Robin; Ramdhaney, Susan; Chapalamadugu, Rajeev; Skoczylas, Leor; Wang, Karen; Rivilis, Svetlana; Remus, Kristin; Mayer, Ira; Iswara, Kadirawel; Tenner, Scott // American Journal of Gastroenterology;Apr2004, Vol. 99 Issue 4, p619 

    OBJECTIVE: Despite advances in diagnostic and therapeutic endoscopy, the mortality of patients with upper gastrointestinal bleeding (UGIB) has remained relatively constant. Inadequate early resuscitation is believed to be a major factor in the persistently high mortality rate in patients with...

  • Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Schuetz, A.; Jauch, K.-W. // Langenbeck's Archives of Surgery;Feb2001, Vol. 386 Issue 1, p17 

    Lower gastrointestinal bleeding (LGIB) is normally treated conservatively or by noninvasive techniques. Emergency operations are only necessary when patients with severe hemorrhage cannot be stabilized by emergency endoscopy or angiography. To improve the postoperative outcome it is of...

  • Gastrointestinal bleeding and obstruction due to giant gallstone impaction in the duodenal bulb. Jamieson, C. P.; Denton, E. R. E.; Swain, C. P.; Srivatsa, S. R.; Burnham, W. R. // Journal of the Royal Society of Medicine;Jan1999, Vol. 92 Issue 1, p19 

    The article presents the medical case of a 62-year-old man with gastrointestinal bleeding and obstruction due to giant gallstone impaction in the duodenal bulb. The patient's medical history is described. The diagnosis on the patient was confirmed by upper gastro-intestinal endoscopy. The...


Read the Article


Sign out of this library

Other Topics