The impact of endoscopy on upper gastrointestinal haemorrhage

Olivia Alexandra Sgarbura¹, Dragos Cinteza¹, Cristian Viorel Poalelungi¹, Dan Cristian²

Summary
Aim: Upper GI haemorrhage (UGIH) is one of the most frequent reasons for referral to gastro-enterology and surgical clinics. This provides a strong motivation for updating diagnostic procedures, and range of therapeutic methods. Oesogastroduodenoscopy is a highly reliable visualising method, classically used for diagnosis but with growing importance in therapy. Our goal is to demonstrate that there is great benefit in accepting endoscopy as a common therapeutic procedure.
Methods: We studied cases of UGIH in an important Romanian clinical hospital throughout 2 years (2001 and 2002), identifying a group of 125 patients (man:woman ratio 1.45) aged between 30 and 87 years (average 58 years, SD = 13.9) that underwent diagnostic endoscopy. We analysed their medical files and evaluated the therapeutic procedures that were applied for the whole group and for aetiologic groups.
Results: In order to evaluate the therapeutic method, we first studied the aetiology and epidemiology of UGIH within the group. We found that the average age of men referred for UGIH was significantly lower than that of women (56.6 y compared to 59.2; p-value < 0.0002) and that gastric ulcer and oesophagitis are significantly more frequent in men (p < 0.0001 and p<0.05), the other causes of UGIH being almost equally distributed. Endoscopic treatment of UGIH occured in 43.2% of cases, only 9.6% of them needing surgery, which was very significant (p = 0). Compared to the approach that Forrest I and Forrest II UGIH have had previously, we noticed the growing role of endoscopy (p < 0.05) and the diminishing role of classic surgery (p < 0.0002) in the studied pathology.
Conclusion: The recent advance that endoscopy has shown as a treatment method is due to its reduced invasivity with less intraoperatory time, less anaesthetic risks, and higher diagnostic and therapeutic efficiency. The recent tendency is to replace classical surgery with endoscopic methods as much as possible, an important step in the treatment of UGIH and obtaining agood outcome.

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