Low utility of endoscopy for suspected upper gastrointestinal bleeding occurring in hospitalized patients.
OBJECTIVE
To determine the clinical utility of upper endoscopy in patients who have upper gastrointestinal bleeding after hospitalization.


METHODS
Patients were studied who underwent upper endoscopy for an indication of suspected upper gastrointestinal bleeding that developed more than 48 hours after hospitalization. Demographic, clinical, and endoscopic data were extracted by chart review. Bleeding was characterized as clinically important (defined as overt bleeding in association with hemodynamic compromise or the need for blood transfusion) or non-clinically important.


RESULTS
Eighty-six patients met inclusion criteria. Clinically important bleeding occurred in 17%. Peptic ulcer disease and gastritis were the most common sources of bleeding in the clinically important and non-clinically important groups, respectively. The bleeding source was not found in 24% of patients. Endoscopic therapy was required in 11% (all of whom had clinically important bleeding). Upper endoscopy prompted no treatment changes in the non-clinically important bleeding group.


CONCLUSIONS
Endoscopic therapy was needed only in the few patients with clinically important bleeding. Nonendoscopic treatment can be recommended for upper gastrointestinal bleeding developing in hospitalized patients who do not meet established criteria for a clinically important bleed.
Kethu
Sripathi R
SR
Division of Gastroenterology, Department of Medicine, Rhode Island Hospital and Brown Medical School, Providence, RI 02903, USA.
Davis
Geoffrey C
GC
Reinert
Steven E
SE
Ramzan
Usman C
UC
Moss
Steven F
SF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D041742:Upper Gastrointestinal Tract / Q000473:pathology / Q000601:surgery