Abstract
Proper evaluation of patients with melena and nondiagnostic esophagogastroduodenoscopy is comparatively undefined. We sought to determine the percentage of patients with melena and nondiagnostic upper endoscopy and assess the yield of further evaluation. Of 209 patients presenting with melena, 180 underwent esophagogastroduodenoscopy as the initial study, which was nondiagnostic in 43 cases (24%). Further evaluation was pursued in 30. A presumed source of melena was found in 11 patients (37%), identified by colonoscopy in seven, bleeding scan in three, and barium enema plus flexible sigmoidoscopy in one. Nearly all such defined cases originated from the right colon. Small bowel contrast studies, flexible sigmoidoscopy or barium enema alone, and angiography failed to reveal a source. Our findings suggest that many (24%) patients presenting with melena will have nondiagnostic upper endoscopy; further evaluation reveals a potential source in 37% of this group, with the right colon being the most likely location of pathology; and colonoscopy is the test of choice in this cohort.
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Wara P, Stodkilde H: Bleeding pattern before admission as guideline for emergency endoscopy. Scand J Gastroenterol 20:72–78, 1985
Holman RAE, Davis M, Gough KR, Gartell P, Britton DC, Smith RB: Value of a centralized approach in the management of haematemesis and melaena: experience in a district general hospital. Gut 31:504–508, 1990
Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J: The national ASGE survey on upper gastrointestinal bleeding. Gastrointest Endosc 27:73–102, 1981
Fleischer D: Etiology and prevalence of severe persistent upper gastrointestinal bleeding. Gastroenterology 84:538–543, 1983
Schiff L, Stevens RJ, Shapiro N, Goodman S: Observations on the oral administration of citrated blood in man. Am J Med Sci 203:409–412, 1942
Aristodemou A, Ryder S, Jacyna MR: Massive haemorrhage due to ulcerative colitis presenting as melaena. Postgrad Med J 68:764–765, 1992
Luke RG, Lees W, Rudick J: Appearance of the stools after the introduction of blood into the caecum. Gut 5:77–79, 1964
Turgeon DK, Barnett JL: Meckel's diverticulum. Am J Gastroenterol 85:777–781, 1990
Tedesco FJ, Pickens CA, Griffin WJ, Sivak MV, Sullivan BH: Role of colonoscopy in patients with unexplained melena: Analysis of 53 patients. Gastrointest Endosc 27:221–223, 1981
Alemayehu G, Jarnerot G: Same-day upper and lower endoscopy in patients with occult bleeding, melena, hematochezia, and/or microcytic anemia. Scand J Gastroenterol 28:667–672, 1993
Chen YK, Gladden DR, Kestenbaum DJ, Collen MJ: Is there a role for upper gastrointestinal endoscopy in the evaluation of patients with occult blood-positive stool and negative colonoscopy? Am J Gastroenterol 88:2026–2029, 1993
Price J, McGuire LJ, Chan MSY: Multiple mystifying melaenas. Br J Radiol 61:521–522, 1988
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Ibach, M.B., Grier, J.F., Goldman, D.E. et al. Diagnostic considerations in evaluation of patients presenting with melena and nondiagnostic esophagogastroduodenoscopy. Digest Dis Sci 40, 1459–1462 (1995). https://doi.org/10.1007/BF02285192
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DOI: https://doi.org/10.1007/BF02285192