Diagnostic yield of endoscopy in upper gastrointestinal bleeding

Area of Science:

• Gastroenterology
• Endoscopy
• Internal Medicine

Background:

• Upper gastrointestinal bleeding (UGIB) presents a diagnostic challenge.
• Timely endoscopic evaluation is essential for identifying the source of bleeding.
• Previous studies highlight the importance of endoscopic findings in UGIB management.

Purpose of the Study:

• To evaluate the diagnostic yield of fibreoptic oesophagogastroduodenoscopy in patients with acute upper gastrointestinal bleeding.
• To determine the correlation between the timing of endoscopy and diagnostic findings.
• To assess the prevalence of various causes of upper gastrointestinal bleeding.

Main Methods:

• Retrospective analysis of 934 fibreoptic oesophagogastroduodenoscopies performed between September 1978 and September 1981.
• Inclusion criteria: 122 patients with symptoms of upper gastrointestinal bleeding of less than two weeks duration.
• Data collection focused on endoscopic findings, patient history (haematemesis, melaena), and timing of the procedure relative to symptom onset.

Main Results:

• Peptic ulcer (40.9%) and oesophageal varices (16.4%) were the most frequent findings in patients with acute UGIB.
• Mucosal lesions were found in 7.4% as isolated findings and 16.4% associated with peptic ulcer or varices.
• Endoscopies were negative in 24.6% of cases; however, no negative findings occurred when endoscopy was performed within 48 hours of bleeding.
• Diagnostic yield was higher in patients with recent haematemesis/melaena (30% negative endoscopy) compared to those without (50% negative endoscopy).

Conclusions:

• Fibreoptic oesophagogastroduodenoscopy is a valuable tool for diagnosing the causes of upper gastrointestinal bleeding.
• Early endoscopy, particularly within 48 hours of symptom onset, maximizes diagnostic yield.
• Symptoms like haematemesis and melaena strongly indicate the need for prompt endoscopic evaluation.