Results of Emergency Gastroscopy for Acute Upper
Gastrointestinal Bleeding Outside Official Hours at King
Chulalongkorn Memorial Hospital
NATHA Y A TANGMANKONGWORAKOON, MD*, RUNGSUN RERKNIMITR, MD*,
SURASAK AEKPONGPAISIT, MD*, PRADERMCHAI KONGKAM, MD*,
PADET VESKITKUL,MD*, PINIT KULLA V ANIJA YA, MB, CUB*
Affiliation : * Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Chulalongkom University, Bangkok 10330,
Thailand.
AbstractThis study was to evaluate the epidemiological characteristics, etiology and therapeutic
outcome of active upper gastrointestinal bleeding in patients who underwent emergency gastroscopy
outside official hours at the Gastroenterology Unit, King Chulalongkom Memorial Hospital. From
January to December 2002, 103 emergency gastroscopies were performed in 99 patients. There were 66
men and 33 women (mean age 55.4 years, range 22-98 years). Causes of bleeding were esophageal
varices (29/99; 29.3% ), gastric ulcer (25/99; 25.3% ), duodenal ulcer (9/99; 9.1% ), gastric varices (9/99;
9 .I%) and miscellaneous ( I2/99; I2 .I%). Etiology of bleeding was uncertain in I 0 .I per cent of the
cases. Therapeutic modalities for variceal bleeding were banding (78.6%), sclerotherapy (I0.7%) and
glue injection (10.7%). Endoscopic therapies for patients with non variceal bleeding were: epinephrine
injection with bipolar coaptation (4 8.1% ), epinephrine injection only (11.1% ), bipolar coaptation alone
(7.4%), heater probe (7.4%), epinephrine injection combined with heater probe (11.1 %), epinephrine
injection with bipolar coaptation and hemoclipping (7.4%), hemoclipping (3.7%), epinephrine injection
with hemoclipping (3.7%). Initial hemostasis was achieved in 91.2 per cent of the patients (91/99).
Recurrent bleeding within 72 hours developed in 9.I per cent of patients (9/99). Of these, eight patients
(88.9%) underwent re-endoscopy and bleeding was stopped in 62.5 per cent (5/8). And 2.0 per cent of
patients (2/99) had to go for emergency surgery after failed therapeutic endoscopy. Overall mortality
was I5.2 per cent (15/99). In conclusion, emergency gastroscopy can offer not only diagnostic but
also therapeutic modality for patients with acute upper gastrointestinal bleeding. Endoscopic therapy
is effective for both initial hemostasis and recurrent bleeding.
Keywords : Gastrointestinal Bleeding, Emergency Gastroscopy, Endoscopic Therapy
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