Therapy

• endoscopy is not necessary for all patients ^d
• endoscopy is safe ^b - though monitor patients who have received midazolam for hypoxia ^a

• Diagnostic endoscopy alone has no clear effect on rebleeding or mortality ^d so may be avoided in patients who stabilise and do not rebleed. ^d
• Endoscopy is safe in acute gastrointestinal bleeding - perforation, aspiration or bleeding are rare ^b

Perforation and aspiration following endoscopy are rare

Complications b	%  (95% CI)	NNF  (95% CI)
perforation	0.24%  (0.030% to 0.45%)	420  (220 to 3400)
aspiration	0.19%  (0.0040% to 0.38%)	520  (270 to 25000)
haemorrhage	0.14%  (0.0% to 0.30%)	700  (340 to infinity)
minor complications	0.43%  (0.15% to 0.71%)	230  (140 to 670)

Midazolam sedation improves tolerance of gastroscopy in elderly patients but increases the risk of hypoxia

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
elderly inpatient undergoing gastroscopy a	midazolam sedation	placebo	tolerance of procedure good or very good at 2 hours	67%	41% (9% to 82%)	4 (2 to 11)
			hypoxia at 2 hours	18%	-140% (-450% to -6%)	-4 (-28 to -2)