Emergency upper gastrointestinal endoscopy: Does haste make waste?


Since it was first advocated some 25 years ago, the tide of medical practice has turned in favor of the "vigorous diagnostic approach" (1) for the management of acute upper gastrointestinal hemorrhage. The principal mandate of this method is that aggressive diagnostic efforts be initiated at the earliest possible moment consistent with safety. The assumptions which underlie this practice are that early efforts can detect with great accuracy the location and nature of the bleeding lesion and that treatment based upon an early, specific diagnosis will be more successful than the nonspecific measures otherwise available. That the first of these assumptions is correct when one considers the application of fiberoptic endoscopy to the diagnosis and management of acute upper gastrointestinal bleeding seems reasonably well established. Table 1 summarizes the frequency with which the actual site of bleeding was believed to have been located in a number of commonly cited medical reports. Rates of diagnostic accuracy between 80 and 100% are common (2-12), particularly when current panendoscopes capable of examining the duodenum as well as the esophagus and stomach are used (5, 6, 13, 14). Although these impressive figures are probably biased in favor of endoscopy by virtue of the fact that the endoscopic diagnosis is often automatically accepted as the correct one, it seems indisputable that the diagnostic accuracy of endoscopy far exceeds that of the clinical history or of barium radiography. The second assumption--that early diagnosis permits more successful the rapy-has been much more difficult to establish. Although it is asserted that endoscopic examination points the way to appropriate therapy (15) and may have a favorable effect on management decisions in as many as 75% of cases (16), some experts (8, 11, 17-21) have questioned wheth-

DOI: 10.1007/BF01072509

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@article{Winans1977EmergencyUG, title={Emergency upper gastrointestinal endoscopy: Does haste make waste?}, author={Charles S. Winans}, journal={The American Journal of Digestive Diseases}, year={1977}, volume={22}, pages={536-540} }