Upper GI bleed: complications from endoscopy were rare

Clinical bottom line (level 4)

  1. The commonest causes of upper GI bleeding were gastric erosions or peptic ulcers.
  2. A sixth of patients had varices.
  3. One patient in twenty-five had cancer.
Gilbert et al: Digestive Diseases and Sciences 1981; 26 (7): 55-59
Expires October 2002

The study

Setting: hospitals, USA

2097 patients (aged mean 57, 66.3%% male) with an upper gastrointestinal bleed
All patients had endoscopy (66% as an emergency). 89% of endoscopies were considered complete.

The evidence


differential diagnosis number of patients prevalence
(95% CI)
gastric erosions 620 29.57%
(28% to 32%)
duodenal ulcer 477 21.32%
(21% to 25%)
gastric ulcer 459 21.89%
(20% to 24%)
varices 323 15.4%
(14% to 17%)
oesophagitis 269 13%
(11% to 14%)
erosive duodenitis 191 9.1%
(7.9% to 10%)
Mallory-Weiss tear 168 8.01%
(6.8% to 9.2%)
neoplasm 78 3.72%
(2.9% to 4.5%)
oesophageal ulcer 46 2.19%
(1.6% to 2.8%)
stomal ulcer 39 1.86%
(1.3% to 2.4%)
Osler-Weber-Rendu telangiectasia haemorrhagica 10 0.48%
(0.18% to 0.77%)
other 152 7.25%
(6.1% to 8.4%)

Comments

  1. Data was collected from 277 members of the American Society of Gastrointestinal Endoscopy who responded to a questionnaire.
  2. The differential diagnosis of upper gastrointestinal bleeding has not changed in the past 20 years since this classic survey was done.
  3. New entities have been recognized, but all these lesions are uncommon causes of upper gastrointestinal bleeding.

Citation

  1. Gilbert DA, Silverstein FE, Tedesco FJ, et al: (supplement): National ASGE Survey on upper gastrointestinal bleeding - complications of endoscopy. Digestive Diseases and Sciences 1981; 26 (7): 55-59
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer: Lawrence Friedman

Clinical Question.
Patient upper GI bleed
Intervention or Exposure presentation to endoscopy
Outcome cause of bleeding