Upper gastrointestinal bleeding other diagnostic studies
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Upper gastrointestinal bleeding Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Other Diagnostic Studies
Nasogastric lavage
- Nasogastric lavage is only indicated when the diagnosis of UGIB doubtful.[1][2]
- It is rarely used now
- Nasogastric lavage also helps in documenting active or recent UGIB and the need for urgent endoscopy.
- Occasionally used to empty gastric contents in preparation for endoscopy.
Interpretation
- Evidence of old (brown colored or 'coffee grounds') or fresh blood documents presence of UGIB.
- Evidence of bilious material rules out bleeding distal to the pylorus.
- Any other appearances of GI contents are non-diagnostic.
- There is no evidence that performing a nasogastric lavage to clear clots or otherwise manage bleeding improves clinical outcome.
- Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult.
- Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult).
- Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate[3]. Cuellar found the following results:
| Finding | Sensitivity | Specificity | Positive predictive value (prevalence of 39%) |
Negative predictive value (prevalence of 39%) |
|---|---|---|---|---|
| Gastroccult | 95% | 82% | 77% | 96% |
| Physician assessment | 79% | 55% | 53% | 20% |
- Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate[5].
Contraindications
- Avoid gastric lavage in patients with suspected perforated abdominal viscus.
Complicatiions
Complications of the procedure include:
- Bleeding from trauma during tube passage in patients with coagulopathy is a possible complication.
- Other rare complications include
- Pharyngeal and esophageal perforation
- Cardiac arrest
- Ethmoid sinus fracture with brain trauma
- Bronchial intubation.
Upper GI Endoscopy
- Upper GI Endoscopy is considered investigation of choice for diagnosing and assessing the source of UGIB.[3][4][5]
- The American Society of Gastrointestinal Endoscopy guidelines recommend that upper gastrointestinal endoscopy be performed within 24 hours of presentation in all patients with UGIB
Indications
- Active UGIB
- Used for biopsy lesions for tissue diagnosis and to treat currently bleeding lesions.
Complications
Complications include
- Aspiration
- Esophageal perforation
- Cardiopulmonary complications secondary to anesthesia
- Increased bleeding while attempting therapeutic intervention
| If upper GI Endoscopy undiagnostic[6] | |||||||||||||||||||||||||
| Patient’s hemodynamic stability | |||||||||||||||||||||||||
| Stable with low volume bleeding | Unstable with large volume bleeding | ||||||||||||||||||||||||
| Repeat endoscopy | Surgery exploration and partial gastrectomy[7] | ||||||||||||||||||||||||
References
- ↑ Pallin DJ, Saltzman JR (2011). "Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated?". Gastrointest. Endosc. 74 (5): 981–4. doi:10.1016/j.gie.2011.07.007. PMID 22032314.
- ↑ Marshall JB (1982). "Management of acute upper gastrointestinal bleeding". Postgrad Med. 71 (5): 149–54, 157–8. PMID 6978482.
- ↑ Cappell MS, Friedel D (2002). "The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders". Med. Clin. North Am. 86 (6): 1165–216. PMID 12510452.
- ↑ Jaskolka JD, Binkhamis S, Prabhudesai V, Chawla TP (2013). "Acute gastrointestinal hemorrhage: radiologic diagnosis and management". Can Assoc Radiol J. 64 (2): 90–100. doi:10.1016/j.carj.2012.08.001. PMID 23245297.
- ↑ Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, Smith J, Jensen ME, Alofaituli G, Gornbein J (2002). "Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots". Gastroenterology. 123 (2): 407–13. PMID 12145792.
- ↑ "Non-variceal upper gastrointestinal haemorrhage: guidelines". Gut. 51 Suppl 4: iv1–6. 2002. PMC 1867732. PMID 12208839.
- ↑ Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002). "Intraoperative endoscopy in laparoscopic colectomy". Surg Endosc. 16 (5): 808–11. doi:10.1007/s00464-001-8226-3. PMID 11997827.