Endoscopy in gastrointestinal bleeding. Are we beginning to realize the dream?

Fiberoptic endoscopy has enabled clinicians to make accurate diagnoses of the cause of acute upper gastrointestinal (GI) bleeding, but, contrary to expectation, that information by itself has not led to improved morbidity or mortality in patients with upper GI bleeding. However, the identification of the so-called stigmata of recent hemorrhage and the subsequent development of effective endoscopic treatments of bleeding lesions have provided hope, based on evidence from numerous clinical trials, that some patients with acute upper GI bleeding will benefit from endoscopic intervention. Injection sclerotherapy, now standard treatment for bleeding esophageal varices, is capable of controlling acute variceal bleeding and is equally effective or better than surgical procedures such as portosystemic shunts and esophageal transection. The question remains whether sclerotherapy of esophageal varices improves survival. With regard to therapeutic endoscopy of bleeding ulcers, multipolar electrocoagulation, laser photocoagulation, and injection of various agents all may be effective and beneficial. All of these methods appear to be capable of controlling acute bleeding and may improve survival, but because of the safety and low cost of injection therapy, that treatment ultimately may be preferred.