Endoscopy for gastrointestinal bleeding

Upper gastrointestinal bleeding

Gastrointestinal bleeding is a secondary pathological condition. The most common causes of upper gastrointestinal bleeding are chronic gastric or duodenal ulcers. In recent years, the number of patients hospitalized for peptic ulcer disease has decreased significantly, but the number of patients with bleeding chronic ulcers remains unchanged.

Patients with gastrointestinal bleeding are divided into 2 groups:

1. Patients who have clear clinical manifestations of ongoing gastrointestinal bleeding, which rapidly worsens the patient's condition. These patients should be examined in the intensive care unit of a surgical hospital, where it is possible to provide assistance up to and including surgery. Restoration of compensatory capabilities should be combined with examination.
2. Patients who had clinical manifestations at the time of admission, but the condition is not severe and is not progressively worsening, and gastrointestinal bleeding is recorded based on the anamnesis and is currently not life-threatening. These patients can be examined in any diagnostic room and in any sequence.

The main causes of gastrointestinal bleeding from the upper gastrointestinal tract

Duodenal ulcer	20-30%
Erosion of the stomach or duodenum	20-30%
Varicose veins of the esophagus and stomach	15-20%
Stomach ulcer	10-20%
Mallory-Weiss syndrome	5-10%
Erosive esophagitis	5-10%
Angioma	5-10%

Fibrogastroduodenoscopy is the most sensitive and informative method of examination for gastrointestinal bleeding. Diagnosis based on clinical data is accurate only in 50% of cases. Gastric X-rays cannot detect most mucosal diseases.

Tasks facing the endoscopist.

1. Find out whether there is ongoing bleeding or not.
2. Determine the intensity of the existing bleeding: - profuse,
   • moderate,
   • weakly expressed.
3. Determine the cause of bleeding: nosological form and localization.
4. Assess the nature of the bleeding source: vessels of the mucous membrane, submucosal or muscular layers, bottom or edges (in case of an ulcer defect).
5. Assess the nature of changes in the tissues surrounding the source of bleeding.
6. Determine whether there is a risk of recurrence of bleeding after the bleeding has stopped.

Classification of gastrointestinal bleeding from the upper gastrointestinal tract.

• Group I. At the time of examination, there is profuse or mild bleeding.
• Group II. Bleeding has stopped, but there is a clear threat of its resumption.
• Group III. At the time of examination, there is no bleeding and there is no obvious threat of its resumption.

An indication for fibroendoscopy is the suspicion or the fact of gastrointestinal bleeding.

Contraindications to fibroendoscopy in gastrointestinal bleeding:

1. If the cause of bleeding is established on the basis of a recent previous study.
2. Technical impossibility of conducting the study due to existing changes or pathological bends in the esophagus.
3. Patients in an agonal state, when establishing a diagnosis does not affect the patient's treatment tactics.

When examining patients with gastrointestinal bleeding, only devices with end-on optics are used.

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