Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit
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To investigate the sources of hemorrhage and use of endoscopic hemostasis in patients with clinically significant upper gastrointestinal (UGI) hemorrhage after admission to the intensive care unit (ICU).
Design and setting
Prospective study, 123 beds of ICU in a 1,629-bed medical center.
Measurements and results
Of the 9,512 consecutive admissions over a 2-year period 105 UGI hemorrhage patients underwent urgent bedside UGI endoscopy. We compared two groups of these patients, one receiving and the other not receiving endoscopic hemostasis. Ulcers with profusely bleeding stigmata occurred in 31 patients (29.5%), ulcers with clean bases or firmly adherent blood clots in 27 (25.7%), stress-related mucosal diseases in 23 (21.9%), esophageal varices in 5 (4.8%), malignancy in 4 (3.8%), and no detectable bleeding site in 15 (14.3%). Endoscopic hemostasis was attempted in 34 patients (32.4%). Primary hemostasis for them was achieved in 67.6% and the rebleeding rate was 30.4%. In-hospital mortality rate was 77.1% and death related to hemorrhage 6.2%. Length of ICU stay before endoscopic diagnosis was significantly shorter in those who underwent endoscopic hemostasis than those who did not (28.2±26.3 vs. 41.2±57.5 days).
Endoscopic hemostasis may be more beneficial when the period between ICU admission and development of hemorrhage is shorter. Bleeders can be more readily identified and controlled endoscopically in such patients. A significant proportion of bleeding sites cannot be identified by UGI endoscopy. It may indicate higher risk of small bowel hemorrhage in these critically ill patients.
KeywordsEndoscopy Upper gastrointestinal tract Hemorrhage Intensive care unit Stress-related mucosal disease
The data analysis of this study benefited from comments and suggestions by Hao-Erl Yang, Professor of Statistics, Graduate School of Management, Tatung University, Taipei, Taiwan.
- 4.Laine L, Peterson WL (1994) Bleeding peptic ulcer. N Engl J Med 331:717–727Google Scholar
- 8.Lewis JD, Shin EJ, Metz DC (2000) Characterization of gastrointestinal bleeding in severely ill hospitalized patients. Crit Care Med 28:46–50Google Scholar
- 9.Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, Winton TL, Rutledge F, Todd TJR, Roy P, Lacroix J, Griffith L, Willan A (1994) Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330:377–381Google Scholar
- 10.Cook D, Heyland DH, Griffith LG, Cook R, Marshall J, Pagliarello J (1999) Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Crit Care Med 27:2812–2817Google Scholar
- 11.Branicki FJ, Coleman SY, Lam TC, Schroeder D, Tuen HH, Cheung WL, Pritchett CJ, Lau PW, Lam SK, Hui WM, Lam DKH, Tse MCK, Wong J (1992) Hypotension and endoscopic stigmata of recent hemorrhage in bleeding peptic ulcer: risk models for rebleeding and mortality. J Gastroenterol Hepatol 7:184–190PubMedGoogle Scholar
- 16.Wolfe M (1994) Stress-related erosive syndrome. In: Bayless T (ed) Current therapy in gastroenterology and liver disease. Mosby-Year Book, St. LouisGoogle Scholar
- 17.Schuster DP, Rowley H, Feinstein S, McGue MK, Zuckerman GR (1984) Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med 76:623–630Google Scholar
- 18.Bruegee WFV, Peura DA (1990) Stress-related mucosal damage: review of drug therapy. J Clin Gastroenterol 12 [Suppl 2]:S35–S40Google Scholar
- 22.Jensen DM (1991) Heater probe for endoscopic hemostasis of bleeding peptic ulcers. Gastrointest Endosc Clin N Am 1:319–339Google Scholar
- 25.Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C (2001) Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 53:147–151Google Scholar
- 26.Bogoch A (1995) Bleeding from the alimentary tract. In: Bockus HL, Berk JE, Schaffner F, Haubrich WS (eds) Gastroenterology, vol 1. Saunders, Philadelphia, pp 61–86Google Scholar
- 27.Cappell MS (1998) Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastrointest Endosc Clin N Am 27:783–825Google Scholar