Intensive Care Medicine

, Volume 29, Issue 10, pp 1723–1728 | Cite as

Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit

  • Yi-Chia Lee
  • Hsiu-Po Wang
  • Ming-Shiang Wu
  • Chang-Shiu Yang
  • Yu-Ting Chang
  • Jaw-Town Lin



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.


Endoscopy 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.


  1. 1.
    Peterson WL, Barnett CC, Smith HJ, Allen MH, Corbett DB (1981) Routine early endoscopy in upper-gastrointestinal-tract bleeding. N Engl J Med 304:925–929PubMedGoogle Scholar
  2. 2.
    Laine L (1990) Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers: a prospective, randomized trial. Gastroenterology 99:1303–1306PubMedGoogle Scholar
  3. 3.
    Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D (1990) Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA 264:494–499PubMedGoogle Scholar
  4. 4.
    Laine L, Peterson WL (1994) Bleeding peptic ulcer. N Engl J Med 331:717–727Google Scholar
  5. 5.
    Rockall TA, Logan RFA, Devlin HB, Northfield TC (1995) Variation in outcome after acute upper gastrointestinal haemorrhage. Lancet 346:346–350PubMedGoogle Scholar
  6. 6.
    Kupfer Y, Cappell MS, Tessler S (2000) Acute gastrointestinal bleeding in the intensive care unit: the intensivist's perspective. Gastroenterol Clin North Am 29:275–307PubMedGoogle Scholar
  7. 7.
    Beejay U, Wolfe MM (2000) Acute gastrointestinal bleeding in the intensive care unit: the gastroenterologist's perspective. Gastroenterol Clin North Am 29:309–336PubMedGoogle Scholar
  8. 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. 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. 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. 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
  12. 12.
    Goldin GF, Peura DA (1996) Stress-related mucosal damage: what to do or not to do. Gastrointest Endosc Clin N Am 6:505–526PubMedGoogle Scholar
  13. 13.
    Brown RB, Klar J, Teres D, Lemeshow S, Sands M (1988) Prospective study of clinical bleeding in intensive care unit patients. Crit Care Med 16:1171–1176PubMedGoogle Scholar
  14. 14.
    Marrone GC, Silen W (1984) Pathogenesis, diagnosis, and treatment of acute gastric mucosal lesions. Clin Gastroenterol 13:635–650PubMedGoogle Scholar
  15. 15.
    Silen W, Mechay A, Sinison JNL (1981) The pathophysiology of stress ulcer disease. World J Surg 5:165–174PubMedGoogle Scholar
  16. 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. 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. 18.
    Bruegee WFV, Peura DA (1990) Stress-related mucosal damage: review of drug therapy. J Clin Gastroenterol 12 [Suppl 2]:S35–S40Google Scholar
  19. 19.
    Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J, and 277 members of the ASGE (1981) The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data. Gastrointest Endosc 27:73–79PubMedGoogle Scholar
  20. 20.
    Rockall TA, Logan RFA, Devlin HB, Northfield TC (1995) Incidence of and mortality from acute upper gastrointestinal hemorrhage in the United Kindom. Steering Committee and Members of the National Audit of Acute Upper Gastrointestinal Hemorrhage. BMJ 311:222–226PubMedGoogle Scholar
  21. 21.
    Sanowski RA, Waring JP (1989) Endoscopic injection therapy for nonvariceal bleeding lesions of the upper gastrointestinal tract. J Clin Gastroenterol 11:247–252PubMedGoogle Scholar
  22. 22.
    Jensen DM (1991) Heater probe for endoscopic hemostasis of bleeding peptic ulcers. Gastrointest Endosc Clin N Am 1:319–339Google Scholar
  23. 23.
    Choudari CP, Rajgopal C, Palmer KR (1992) Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer hemorrhage. Gut 33:1159–1161PubMedGoogle Scholar
  24. 24.
    Lin HJ, Lee FY, Kang WM, Tsai YT, Lee SD, Lee CH (1990) Heat probe thermocoagulation and pure alcohol injection in massive peptic ulcer haemorrhage: a prospective, randomized controlled trial. Gut 31:753–757PubMedGoogle Scholar
  25. 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. 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. 27.
    Cappell MS (1998) Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastrointest Endosc Clin N Am 27:783–825Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Yi-Chia Lee
    • 1
  • Hsiu-Po Wang
    • 2
  • Ming-Shiang Wu
    • 3
  • Chang-Shiu Yang
    • 1
  • Yu-Ting Chang
    • 3
  • Jaw-Town Lin
    • 3
  1. 1.Department of Internal MedicineEn Chu Kong HospitalTaipeiTaiwan
  2. 2.Department of Emergency Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  3. 3.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan

Personalised recommendations