IMPORTANCE OF DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY IN UPPER GASTROINTESTINAL BLEEDING

Abstract

The aim of this study was to determine the role of urgent therapeutic endoscopy (TE) in the treatment of upper gastrointestinal bleeding (UGB). Data of 351 consecutive patients was evaluated retrospectively. The patients were separated into two groups: first group included patients between 1995 and 1998 where endoscopy was primarily used for diagnostic purposes and the second group included patients whom endoscopy was employed for therapeutic purposes between 1999 and 2002. These groups were compared to each other according to the purpose of endoscopy (diagnostic vs. therapeutic), need for surgery, number of blood product transfusions, mortality rates, and duration of hospitalization. Group 1 included a total of 153 (mean age 49 years) acute UGB patients. Endoscopy was performed in 1 70 (70%) of these patients within an average time of 23 hours period after admission, and TE was performed in only 5 (3%) patients. 198 patients formed group 2 and endoscopy was employed in 190 (98%) patients within an average time of 4 hours after admission. Endoscopic injection therapy (sol. 1:10000 adrenaline) was performed in 58 (29%) patients and endoscopic band ligation was performed in 28 (14%) patients. When group 2 patients were compared to group 1 patients, significant reduction in the need for surgery (from 35% down to 7.5%; p<0.0005), the mean transfusion number (from 4.7 units down to 3.8 units; p<0.05) and mortality rates (from 25.5% down to 8%; p<0.0005) were detected. There was no significant difference in surgical mortality (41% vs. 33%) between groups (p>0.05). There was no significant difference in the mean age and duration of hospitalization between groups (p>0.05).

We concluded that urgent TE significantly reduces the need for surgery, number of blood transfusions and mortality rates in patients with acute UGB.