The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. A 23-year prospective study of 1,4000 patients

Abstract

Diagnostic management of 1,400 patients with severe, active upper-gastrointestinal tract hemorrhage by immediate esophagogastroscopy and contrast roentgenography provided confident identification of the bleeding lesion in 93%. Preexamination ice-water lavage of the stomach by Ewald tube and syringe proved remarkably effective for control of active hemorrhage. Seven hundred and eleven potentially bleeding lesions that were not playing a part in the hemorrhage were discovered. Duodenal ulcer was responsible for only one fourth of the hemorrhages. Erosive esophagitis and erosive gastritis were the cause of approximately 7% and 12% of the hemorrages, respectively, with death rates of 3% and 9%, respectively. There was one endoscopic injury (perforation through Zenker's diverticulum). Emergency surgical treatment was necessary to control hemorrhage in 16.1% of the 1,400 patients. The overall mortality was 7.9%.