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01-12-2018 | Original Article

Lower Endoscopic Diagnostic Yields Observed in Non-hematemesis Gastrointestinal Bleeding Patients

Authors: Salmaan Jawaid, Neil Marya, Bilal Gondal, Louise Maranda, Christopher Marshall, Joseph Charpentier, Abbas Rupawala, Muhammad Al-Sayid, Anupam Singh, Anne Foley, Gregory Volturo, David Cave

Published in: Digestive Diseases and Sciences | Issue 12/2018

Abstract

Background

Location of bleeding can present a diagnostic challenge in patients without hematemesis more so than those with hematemesis.

Aim

To describe endoscopic diagnostic yields in both hematemesis and non-hematemesis gastrointestinal bleeding patient populations.

Methods

A retrospective analysis on a cohort of 343 consecutively identified gastrointestinal bleeding patients admitted to a tertiary care center emergency department with hematemesis and non-hematemesis over a 12-month period. Data obtained included presenting symptoms, diagnostic lesions, procedure types with diagnostic yields, and hours to diagnosis.

Results

The hematemesis group (n = 105) took on average 15.6 h to reach a diagnosis versus 30.0 h in the non-hematemesis group (n = 231), (p = 0.005). In the non-hematemesis group, the first procedure was diagnostic only 53% of the time versus 71% in the hematemesis group (p = 0.02). 25% of patients in the non-hematemesis group required multiple procedures versus 10% in the hematemesis group (p = 0.004). Diagnostic yield for a primary esophagogastroduodenoscopy was 71% for the hematemesis group versus 50% for the non-hematemesis group (p = 0.01). Primary colonoscopies were diagnostic in 54% of patients and 12.5% as a secondary procedure in the non-hematemesis group. A primary video capsule endoscopy yielded a diagnosis in 79% of non-hematemesis patients (n = 14) and had a 70% overall diagnostic rate (n = 33).

Conclusion

Non-hematemesis gastrointestinal bleeding patients undergo multiple non-diagnostic tests and have longer times to diagnosis and then compared those with hematemesis. The high yield of video capsule endoscopy in the non-hematemesis group suggests a role for this device in this context and warrants further investigation.

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Title: Lower Endoscopic Diagnostic Yields Observed in Non-hematemesis Gastrointestinal Bleeding Patients
Authors: Salmaan Jawaid
Neil Marya
Bilal Gondal
Louise Maranda
Christopher Marshall
Joseph Charpentier
Abbas Rupawala
Muhammad Al-Sayid
Anupam Singh
Anne Foley
Gregory Volturo
David Cave
Publication date: 01-12-2018
Publisher: Springer US
Published in: Digestive Diseases and Sciences / Issue 12/2018
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-018-5244-8

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Abstract

Background

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Results

Conclusion

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