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Current management of upper gastrointestinal bleeding.

R D Yajko, L W Norton, B Eiseman

    Annals of Surgery
    |April 1, 1975
    PubMed
    Summary
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    This study on massive upper gastrointestinal bleeding found that diagnostic endoscopy and angiography improved identification of bleeding sources. Surgical intervention decreased over four years, with improved outcomes for ulcer disease.

    Area of Science:

    • Gastroenterology
    • Surgical Gastroenterology
    • Interventional Radiology

    Background:

    • Massive upper gastrointestinal bleeding (UGIB) presents a significant clinical challenge with high morbidity and mortality.
    • Traditional diagnostic methods have limitations in identifying the precise source of bleeding.
    • Surgical intervention rates for UGIB have historically been high, contributing to patient risk.

    Purpose of the Study:

    • To evaluate diagnostic modalities and treatment outcomes for patients hospitalized with massive upper gastrointestinal bleeding.
    • To assess trends in surgical intervention rates and operative mortality over a four-year period.
    • To compare the efficacy of different surgical and non-surgical interventions for various causes of UGIB.

    Main Methods:

    • Retrospective analysis of 585 patients hospitalized for massive UGIB over four years.

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  • Endoscopy and selective angiography were used for diagnosis and localization of bleeding sites.
  • Data on surgical interventions, causes of bleeding, operative procedures, and mortality were collected and analyzed.

    • Main Results:

    • Endoscopy diagnosed bleeding causes in 80% of studied patients; angiography localized bleeding in 12/20.
    • Surgical intervention rates decreased from 33% to 13% over the study period.
    • Benign ulcer disease was the most common cause in surgical patients (51%); operative mortality was 29% overall, but lower for duodenal ulcers (18%) treated with vagotomy and pyloroplasty.

    Conclusions:

    • Increasing use of gastroscopy and selective angiography enhances diagnostic accuracy for UGIB.
    • Vasopressor infusion may reduce the need for surgery in certain conditions like gastritis and stress ulcers.
    • While surgical outcomes for ulcer disease are improving, conditions like stress ulcers and varices remain associated with high mortality.