[Immediate endoscopic diagnosis in upper gastrointestinal hemorrhage (analysis of 79 cases)]

In 102 cases with massive upper digestive hemorrhage, the method of immediate endoscopic diagnosis was used. From these 79 were selected which permitted an integral analysis. Upon the patient's gastric pumping with iced water was effected, and then emergency esophago-gastro-duodenoscopy was performed. Intravenous or intramuscular Diazepan or Meperidine, anticholinergics, and local anesthesia were used as pre-medication. In patients in a critical condition only local anesthesia and anticholinergics were used. Once the diagnosis had been made the method to be followed was planned. There were no complications either in the preparation of the endoscopy itself. Diagnostic certainty was of 91%. General mortality was 13,9%. The most frequent diagnosis was that of Duodenal Ulcer with 31,6%, followed by Gastric Ulcer with 24,1%, and Hemorrhagic Gastritis with 22,8%. Of the total, 34,2% were submitted to emergency laparotomy after the endoscopy. Immediate endoscopy is a useful procedure for massive upper digestive hemorrhage since it provides an etiological and topographical diagnosis thus indicating a specific treatment. In this way the general mortality rate and the percentage of patients submitted to exploratory laparotomy have decreased.