Bleeding pattern before admission as guideline for emergency endoscopy

In a prospective study of 539 patients admitted because of hematemesis and melena the bleeding pattern before admission was compared with the findings obtained on emergency endoscopy and the subsequent clinical course. Ranked in order of prognostic importance, red hematemesis with melena, black hematemesis with melena, and red hematemesis alone increased the probability of massive hemorrhage. Moreover, black hematemesis with melena was the superior predictor of bleeding ulcer, the commonest lesion carrying the risk of massive hemorrhage. In contrast, in patients with melena or black hematemesis alone massive hemorrhage occurred comparatively infrequently. The order of prognostic importance was supported by the transfusion requirement. In screening for a potentially life-threatening ulcer hemorrhage, emergency endoscopy is recommended in patients with black hematemesis with melena or with red hematemesis with or without melena. In patients presenting with black hematemesis or melena alone endoscopy may be postponed to the next convenient daytime.