title: Factors affecting delection of bleeding lesions in the stomach by initial emergency endoscopy.
abstract: BACKGROUND
  Accurate endoscopic diagnosis of acute gastric bleeding can be problematic and missing diagnoses are not uncommon. However, the causes of diagnostic difficulty and the most common locations of bleeding resulting in missed diagnosis are not well known.
  
  
  METHODS
  To determine the causative factors of incomplete study, we analyzed the medical records and performed follow-up on 64 patients for whom initial emergency endoscopy had failed to identify the sites of acute gastric bleeding. The bleeding sites were confirmed by the findings of subsequent endoscopic examination or operation in these cases.
  
  
  RESULTS
  Excessive blood covering the examination field was the most frequent cause of incomplete endoscopic study (60/64). Underlying gastric lesions which were later identified as sources of gastric bleeding included: 30 gastric ulcers, 9 gastric varices, 6 acute gastric mucosal lesions, 3 Dieulafoy's lesions, 3 portal hypertensive gastropathies, 2 gastric tumors, 1 Mallory-Weiss tear and 2 unidentified bleeding sites. Eight patients refused further evaluation. The locations of the bleeding sites included: 1 esophagocardiac junction, 8 cardia, 5 fundus, 21 body, 9 antrum, 7 stoma, 3 diffuse pattern. The 42-day mortality rate of these patients was 20%. Of these patients, decompensated liver cirrhosis (8/13) and hepatic failure (7/13) were the most common underlying diseases.
  
  
  CONCLUSIONS
  Inadequate preparation was the most frequently procedural problem associated with missed diagnosis. Lesions located in the body of the stomach were most likely to go undiagnosed. Gastric ulcers were the most common type of unidentified bleeding ulcer site. Hepatic failure was the most common cause of death. The high mortality rate of these patients appeared to be related to underlying diseases rather than to the nature of the lesions responsible for gastric bleeding.
authors.affiliation: Department of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.OC.
authors.forename: C H
authors.initials: CH
authors.lastname: Wu
authors.forename: F H
authors.initials: FH
authors.lastname: Chen
authors.forename: C S
authors.initials: CS
authors.lastname: Lee
authors.forename: C Y
authors.initials: CY
authors.lastname: Lin
authors.forename: P C
authors.initials: PC
authors.lastname: Chen
authors.forename: C S
authors.initials: CS
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged