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August 1973

Early EndoscopyA Guide to Therapy for Acute Hemorrhage in the Upper Gastrointestinal Tract

Author Affiliations

From the Department of Surgery, Wayne State University School of Medicine, Detroit, and the Detroit General Hospital.

Arch Surg. 1973;107(2):133-137. doi:10.1001/archsurg.1973.01350200007004

The surgical endoscopy unit at Detroit General Hospital has examined 183 patients with acute hemorrhage in the upper gastrointestinal tract during the past 14 months. Most patients (160) were examined within 48 hours of admission. The esophagogastroduodenoscope was used throughout. Successful visualization of the esophagogastroduodenal area was accomplished in 178 patients (97%).

The primary cause of bleeding as judged endoscopically was acute gastric erosion due to alcohol or salicylates in 75 patients, benign ulcer disease in 52, Mallory-Weiss syndrome in 27, and esophageal varices in eight. Sixty-eight patients (43%) had more than one source of bleeding. Intraoperative endoscopy in 12 patients circumvented the need for exploratory gastrotomy. The high incidence of superficial lesions correlated well with the high incidence of negative barium study (67%) in these patients.