What is the role of endoscopy in the workup of pediatric gastrointestinal (GI) bleeding?

Updated: Dec 19, 2018
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Robert K Minkes, MD, PhD  more...
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Patients with severe upper GI bleeding should receive endoscopy within the first 12 hours of the hemorrhagic episode if they are sufficiently stable, because early endoscopy improves the diagnostic index.

The site of upper GI bleeding can be identified in 90% of cases when endoscopy is performed within 24 hours. This modality is also beneficial in predicting the likelihood of continued bleeding. [8]

The Forress classification divides endoscopic findings into the following 3 categories:

  • I - Active hemorrhage (Ia = bright-red bleeding, Ib = slow bleeding)

  • II - Recent hemorrhage (IIa = nonbleeding visible vessel, IIb = adherent clot on base of lesion, IIc = flat pigmented spot)

  • III - No evidence of bleeding.

The incidence of rebleeding decreases dramatically, because less evidence of ulceration or bleeding is seen.

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