Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Prospective, randomized study of diagnosis and outcome in acute upper-gastrointestinal bleeding: Endoscopy versus conventional radiography

  • 30 Accesses

  • 37 Citations


Sixty patients with mild to moderate upper-gastrointestinal bleeding were admitted to a prospective, controlled study of diagnosis and management, and were randomized to endoscopy or upper-gastrointestinal (UGI) barium series as the initial study. Definitive localization of the source of bleeding was made initially in 69% of the endoscopy group and 21% of the UGI group (P<0.0005). Of 54 patients undergoing both studies, endoscopy was definitive in 67% and UGI series in 22%. Thus, endoscopy also made more diagnoses when used as the second study (P<.01). The use of endoscopy as the initial procedure led to significantly more rapid diagnosis than with UGI series. However, there were no significant differences between the two groups in clinical outcome. Endoscopy is the initial diagnostic procedure of choice in patients with mild to moderate upper-gastrointestinal bleeding because it enables detection of superficial bleeding lesions and has significantly increased the speed of diagnosis.

This is a preview of subscription content, log in to check access.


  1. 1.

    Palmer ED: The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. A 23 year prospective study of 1400 patients. JAMA 207:1477–1480, 1969

  2. 2.

    Hirschowitz BI, Luketic GC, Balint JA, Fulton WF: Early fiberscope endoscopy for upper gastrointestinal bleeding. Am J Dig Dis 8:816–825, 1963

  3. 3.

    Katz D, Douvres P, Weisberg H, McKinnon W, Jerzy Glass GB: Early endoscopic diagnosis of acute gastrointestinal hemorrhage. JAMA 188:405–408, 1964

  4. 4.

    Katon RM, Smith FW: Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding. Gastroenterology 65:728–734, 1973

  5. 5.

    Sugawa C, Werner WH, Hayes DF, Lucas CE, Walt AJ: Early endoscopy. A guide to therapy for acute hemorrhage in the upper-gastrointestinal tract. Arch Surg 107:133–137, 1973

  6. 6.

    Sandlow LJ, Becker GH, Spellberg MA, Allen HA, Berg G, Berry LA, Newman EA: A prospective, randomized study of management of upper-gastrointestinal hemorrhage. Am J Gastroenterol 61:282–289, 1974

  7. 7.

    Dixon WS, Massey FJ, Jr: Introduction to Statistical Analysis. Third Edition, New York, McGraw-Hill Book Company, 1969

  8. 8.

    Belber JP: Endoscopic examination of the duodenal bulb: A comparison with X-ray. Gastroenterology 61:55–61, 1971

  9. 9.

    Cotton PB, Rosenberg MT, Waldram APL, Axon ATR: Early endoscopy of esophagus, stomach, and duodenal bulb in patients with hematemesis and melena. Br Med J 2:505–509, 1973

  10. 10.

    Palmer ED, Brick IB: Sources of upper-gastrointestinal hemorrhage in cirrhotic patients with esophageal varices. N Engl J Med 248:1057–1058, 1953

  11. 11.

    Conn HO, Brodoff M: Emergency esophagoscopy in the diagnosis upper gastrointestinal hemorrhage. Gastroenterology 47:505–512, 1964

  12. 12.

    McCray RS, Martin F, Amir-Ahmadi H: Erroneous diagnosis of hemorrhage from esophageal varices. Am J Dig Dis 14:755–759, 1969

Download references

Author information

Correspondence to Dr. Gary M. Levine MD.

Additional information

The following are members of the Gastrointestinal Section of the University of Pennsylvania. Staff: Drs. Frank P. Brooks, Sidney Cohen, Julius J. Deren, Anthony J. DiMarino, Jr., William B. Long, Geobel A. Marin, J. Donald Ostrow, Roger D. Soloway, Bruce W. Trotman, and Jordan W. Weiss.

Trainees: Drs. Dominic Comperatore, Thomas J. Devers, Robert G. Knodell, Gary M. Levine, John R. Mathias, David W. Morris, Stewart D. Shull, William J. Snape, Jr., Monroe H. Spector, Edward J. Tapper, and Charles I. Wagner.

Supported in part by a National Institutes of Health training grant (AMO5462) and a Veterans Administration training grant (TR15).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Morris, D.W., Levine, G.M., Soloway, R.D. et al. Prospective, randomized study of diagnosis and outcome in acute upper-gastrointestinal bleeding: Endoscopy versus conventional radiography. Digest Dis Sci 20, 1103–1109 (1975). https://doi.org/10.1007/BF01070752

Download citation


  • Public Health
  • Clinical Outcome
  • Barium
  • Diagnostic Procedure
  • Initial Study