Skip to main content
SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

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).

Conclusions

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.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Peterson WL, Barnett CC, Smith HJ, Allen MH, Corbett DB (1981) Routine early endoscopy in upper-gastrointestinal-tract bleeding. N Engl J Med 304:925–929

    CAS  PubMed  Google Scholar 

  2. Laine L (1990) Multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers: a prospective, randomized trial. Gastroenterology 99:1303–1306

    CAS  PubMed  Google Scholar 

  3. Sacks HS, Chalmers TC, Blum AL, Berrier J, Pagano D (1990) Endoscopic hemostasis. An effective therapy for bleeding peptic ulcers. JAMA 264:494–499

    CAS  PubMed  Google Scholar 

  4. Laine L, Peterson WL (1994) Bleeding peptic ulcer. N Engl J Med 331:717–727

    Google Scholar 

  5. Rockall TA, Logan RFA, Devlin HB, Northfield TC (1995) Variation in outcome after acute upper gastrointestinal haemorrhage. Lancet 346:346–350

    CAS  PubMed  Google Scholar 

  6. Kupfer Y, Cappell MS, Tessler S (2000) Acute gastrointestinal bleeding in the intensive care unit: the intensivist's perspective. Gastroenterol Clin North Am 29:275–307

    CAS  PubMed  Google Scholar 

  7. Beejay U, Wolfe MM (2000) Acute gastrointestinal bleeding in the intensive care unit: the gastroenterologist's perspective. Gastroenterol Clin North Am 29:309–336

    CAS  PubMed  Google Scholar 

  8. Lewis JD, Shin EJ, Metz DC (2000) Characterization of gastrointestinal bleeding in severely ill hospitalized patients. Crit Care Med 28:46–50

    Google 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 330:377–381

    Google 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 27:2812–2817

    Google 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 7:184–190

    CAS  PubMed  Google Scholar 

  12. Goldin GF, Peura DA (1996) Stress-related mucosal damage: what to do or not to do. Gastrointest Endosc Clin N Am 6:505–526

    CAS  PubMed  Google Scholar 

  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 16:1171–1176

    CAS  PubMed  Google Scholar 

  14. Marrone GC, Silen W (1984) Pathogenesis, diagnosis, and treatment of acute gastric mucosal lesions. Clin Gastroenterol 13:635–650

    CAS  PubMed  Google Scholar 

  15. Silen W, Mechay A, Sinison JNL (1981) The pathophysiology of stress ulcer disease. World J Surg 5:165–174

    CAS  PubMed  Google Scholar 

  16. Wolfe M (1994) Stress-related erosive syndrome. In: Bayless T (ed) Current therapy in gastroenterology and liver disease. Mosby-Year Book, St. Louis

  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 76:623–630

    Google Scholar 

  18. Bruegee WFV, Peura DA (1990) Stress-related mucosal damage: review of drug therapy. J Clin Gastroenterol 12 [Suppl 2]:S35–S40

  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 27:73–79

    CAS  PubMed  Google Scholar 

  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 311:222–226

    CAS  PubMed  Google Scholar 

  21. Sanowski RA, Waring JP (1989) Endoscopic injection therapy for nonvariceal bleeding lesions of the upper gastrointestinal tract. J Clin Gastroenterol 11:247–252

    CAS  PubMed  Google Scholar 

  22. Jensen DM (1991) Heater probe for endoscopic hemostasis of bleeding peptic ulcers. Gastrointest Endosc Clin N Am 1:319–339

    Google Scholar 

  23. Choudari CP, Rajgopal C, Palmer KR (1992) Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer hemorrhage. Gut 33:1159–1161

    CAS  PubMed  Google Scholar 

  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 31:753–757

    CAS  PubMed  Google 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 53:147–151

    Google 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 61–86

  27. Cappell MS (1998) Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastrointest Endosc Clin N Am 27:783–825

    CAS  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, En Chu Kong Hospital, Taipei, Taiwan

    Yi-Chia Lee & Chang-Shiu Yang

  2. Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Hsiu-Po Wang

  3. Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan

    Ming-Shiang Wu, Yu-Ting Chang & Jaw-Town Lin

Authors
  1. Yi-Chia Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hsiu-Po Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming-Shiang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chang-Shiu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu-Ting Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jaw-Town Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaw-Town Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, YC., Wang, HP., Wu, MS. et al. Urgent bedside endoscopy for clinically significant upper gastrointestinal hemorrhage after admission to the intensive care unit. Intensive Care Med 29, 1723–1728 (2003). https://doi.org/10.1007/s00134-003-1921-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-1921-x

Keywords

Search

Navigation