Urgent fibre-optic panendoscopy in upper gastro-intestinal haemorrhage.

Urgent fibre-optic panendoscopy was performed in 400 patients within 24 hours of their admission to hospital for upper gastro-intestinal haemorrhage. The cause of bleeding was established by endoscopy in 87%. No cause was found in 10% and endoscopy failed in 3%. Twenty-five per cent of the patients had an additional lesion which was not the cause of bleeding. Complications owing to endoscopy occurred in 2% of the patients. Only 27% of the patients still had blood present in the stomach at the time of endoscopy. Chronic gastric ulcer was causative in 22%, and duodenal ulcer in 20% of the patients. Haemorrhagic gastritis accounted for 13%, Mallory-Weiss tear for 8%, acute ulceration for 5% and varices for 4% of the patients. Only 60% of the patients with dyspepsia were bleeding from peptic ulcers and only 64% of the patients bleeding from ulcers had a history of dyspepsia. Follow-up studies revealed that endoscopy, in experienced hands, is an accurate investigation which allows for an improved approach to management, and which probably also reduces the mortality rate.