A prospective reappraisal of emergency endoscopy in patients with portal hypertension

In a prospective study of emergency endoscopy in patients with portal hypertension and oesophageal varices referred to King's College Hospital with acute upper gastrointestinal bleeding, initial endoscopic examination on 90 separate consecutive hospital admissions carried out within 24 h of clinical haemorrhage showed active variceal bleeding in only 21 (23.3%) cases. Coexisting upper gastrointestinal lesions were present in 38.8% of examinations, but active bleeding from these sites was seen in only five cases (5.6%). Of the 64 cases in which no active bleeding was seen at initial endoscopy, 39 (60.9%) rebled during that admission, and repeat endoscopy in 27 of these, carried out within 1 h of this episode, revealed active variceal haemorrhage in 20 (74.1%) cases. These results indicate that variceal haemorrhage is intermittent, and, although bleeding may often stop spontaneously, a high proportion of patients subsequently rebleed, and this is invariably from varices rather than from coexisting upper gastrointestinal lesions. In addition, these findings confirm the importance of emergency endoscopy in making the correct decision about acute management.