What is the role of endoscopy in the workup of upper gastrointestinal bleeding (UGIB)?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

The development of endoscopy has provided clinicians with the ability for diagnostic and therapeutic approaches to bleeding from the gastrointestinal (GI) tract. Endoscopic examination of the upper GI tract provides useful information regarding the source and site of bleeding. [31, 88, 89]

Endoscopic findings and their incidence rate in patients with upper GI bleeding (UGIB) include the following:

  • Duodenal ulcer: 24.3%
  • Gastric erosion: 23.4%
  • Gastric ulcer: 21.3%
  • Esophageal varices: 10.3%
  • Mallory-Weiss tear: 7.2%
  • Esophagitis: 6.3%
  • Duodenitis: 5.8%
  • Neoplasm: 2.9%
  • Stomal (marginal) ulcer: 1.8%
  • Esophageal ulcer: 1.7%
  • Other/miscellaneous: 6.8%

Endoscopy should be performed immediately after endotracheal intubation (if indicated), hemodynamic stabilization, and adequate monitoring in an intensive care unit (ICU) setting have been achieved. Optimize conditions for performing endoscopy, including involvement of multidisciplinary support, obtaining appropriate informed consent, and ensuring the availability of appropriate equipment and personnel. Endoscopy typically takes place within 24 hours. Early studies have shown that emergent endoscopy, within 12 hours or less from presentation, may reveal a higher-risk stigmata of bleeding on endoscopy and require therapeutic intervention, but other clinical endpoints such as the need for surgical intervention, length of stay, and mortality are not significantly impacted. [106, 107, 108]


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