[Non-variceal bleeding from the upper gastrointestinal tract].
Bleeding from the upper part of gastrointestinal tract is very often complication of gastrointestinal diseases. Bleeding is one of the most common cause of hospitalisation in surgical wards. It's found in 15-20% gastric and duodenal ulcer. Bleeding's occurrence is 50-100 on 100,000 citizens.


OBJECTIVE
Answers on questions: what was the best procedure with bleeding patient, what were indications to urgent endoscopy in bleeding, what was the best time to endoscopy and what was influence of endoscopy for volume of transfused blood in bleeding patient.


METHODS
In the years 1999-2003 81 patients were treated by endoscopy because of bleeding from the upper gastrointestinal tract in Ward of General Surgery in hospital in Zyrardow. There were 31 women in medium age 68 and 50 men in medium age 57. All group was divided on 3 smaller groups: A--patients endoscoped in 6 hours from admitting, B--6-12 hours from admitting and C--12-24 hours from admitting. Each place and kind of bleeding was diagnosed in every case and each bleeding was classified to appropriate group according to Forrest's scale, each was treated by an injection endoscopic therapy (adrenalin was used in concentration 1:10.000 in 0.9% of natrium chloratum).


RESULTS
Full hemostasis was achieved in 95.1% cases. The recurrence of bleeding was stated in 6 cases (7.4%), in 2 cases (2.5%) hemostasis was obtained by endoscopy (second-look endoscopy), 4 patients (5%) were operated on because of the recurrence and the dynamics of bleeding as well as the lack of possibility of carrying out the endoscopy. Four deaths (5%) were stated although the bleeding of the upper gastrointestinal tract was not the direct reason. The bleeding in each patient was restrained in our own capacity and nobody was directed to a hospital of higher level of reference.It was stated that the endoscopy of upper gastrointestinal tract gave the best effects if it was done as quickly as possible after the patient had been admitted to hospital - in this material 6 hours from admitting. It allows us to diagnose the cause of bleeding and to treat the disease at the time of diagnosing as well as to reduce of the amount of transfused blood. It also makes possible to prepare elective operation, that is to say "buy" time needed for operation when the endoscopy is not sufficient for successful healing.


CONCLUSIONS
Endoscopy is the right and repeatable diagnostic and therapeutic tool for treating the bleeding from the upper part of the gastrointestinal tract which allows us to avoid the unnecessary laparotomy. It also makes possible to plan and control the procedure in the circumstances of bleeding from the upper part of gastrointestinal tract. In relation to not numerous contradictions endoscopic therapy of bleeding from the upper gastrointestinal tract should be fundamental diagnostic and healing method in bleeding from the upper part of gastrointestinal tract in each medical unit, which posseses suitable equipment and qualified staff.
Wójtowicz
Jacek
J
Surgical Ward of District Hospital in Zyrardów.ilitary Institute of Health Services in Warsaw, Department of Gastroenterology, Central Clinical Hospital of the Ministry of National Defense.
Wojtuń
Stanisław
S
Gil
Jerzy
J
D017677:Age Distribution; D000368:Aged; D015984:Causality; D015897:Comorbidity; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D017678:Sex Distribution; D041742:Upper Gastrointestinal Tract