Failure of endoscopy to establish a source for upper gastrointestinal bleeding

Area of Science:

• Gastroenterology
• Endoscopy
• Hepatology

Background:

• Upper gastrointestinal bleeding (UGIB) is a common medical emergency.
• Endoscopic examination is the primary diagnostic tool for identifying UGIB sources.
• Diagnostic challenges arise when the bleeding source is not immediately apparent during endoscopy.

Purpose of the Study:

• To analyze cases where emergency endoscopic examination failed to identify the source of upper gastrointestinal bleeding.
• To evaluate the significance of large esophagogastric varices as a potential bleeding source in these challenging cases.

Main Methods:

• Retrospective analysis of 500 patients undergoing emergency endoscopy for UGIB.
• Focus on a subgroup of 55 patients (11%) where the bleeding source was not identified.
• Detailed examination of clinical data and endoscopic findings in this subgroup.

Main Results:

• In 55 patients, emergency endoscopy did not identify the bleeding source.
• Thirty-seven of these patients had large and extensive esophagogastric varices.
• These varices, though not actively bleeding during examination, were considered a significant potential source of UGIB.

Conclusions:

• Large esophagogastric varices should be considered a significant potential source of upper gastrointestinal bleeding, even without visible signs of rupture.
• When varices are the sole potential source, they can be reasonably assumed to be the cause, guiding specific treatment.
• This finding has clinical implications for managing patients with unexplained upper gastrointestinal bleeding.