A critical look at the accuracy of endoscopy and double-contrast radiography of the upper gastrointestinal (UGI) tract in patients with substantial UGI hemorrhage.
Double-contrast radiography and endoscopy were compared in a prospective study of 100 patients with substantial hemorrhage of the upper gastrointestinal (UGI) tract. Endoscopy enabled detection of the primary bleeding site in 93% of the patients and correct diagnosis of 91% of all UGI lesions present. Double-contrast radiography detected 80% of primary bleeding sites and 76% of all UGI lesions present; whether the double-contrast examination was performed before or after endoscopy did not change its ability to detect lesions. Radiography demonstrated 68% (esophagitis) to 86% (duodenitis) of all superficial lesions. Endoscopy missed lesions in the duodenum and esophagus most frequently, while double-contrast radiography missed lesions in the esophagus most frequently. With the two modalities combined, the overall diagnostic accuracy for all lestions was 99%. Endoscopy and double-contrast radiography are complementary techniques for detecting acute bleeding sites of the UGI tract.
D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D004064:Digestive System / Q000000981:diagnostic imaging; D004724:Endoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging; D008722:Methods; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography