Upper gastrointestinal bleeding other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Nasogastric lavage and UpperGI endoscopy are other diagnostic studies that are helpful in the diagnosis of upper gastrointestinal bleeding. Evidence of old (brown colored or 'coffee grounds') or fresh blood documents on nasogastric lavage indicates the presence of UGIB.
Other Diagnostic Studies
Nasogastric lavage
- Nasogastric lavage is only indicated when the diagnosis of UGIB doubtful.[1][2]
- It is rarely used.
- Nasogastric lavage also helps in documenting active or recent UGIB and the need for urgent endoscopy.
- Occasionally used to empty gastric contents in preparation for endoscopy.
Interpretation
- Evidence of old (brown colored or 'coffee grounds') or fresh blood documents presence of UGIB.
- Evidence of bilious material rules out bleeding distal to the pylorus.
- Any other appearances of GI contents are non-diagnostic.
- There is no evidence that performing a nasogastric lavage to clear clots or otherwise manage bleeding improves clinical outcome.
- Determining whether blood is in gastric contents, either vomited or aspirated specimens, is surprisingly difficult.
- Slide tests are based on orthotolidine (Hematest reagent tablets and Bili-Labstix) or guaiac (Hemoccult and Gastroccult).
- Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate[3]. Cuellar found the following results:
| Finding | Sensitivity | Specificity | Positive predictive value (prevalence of 39%) |
Negative predictive value (prevalence of 39%) |
|---|---|---|---|---|
| Gastroccult | 95% | 82% | 77% | 96% |
| Physician assessment | 79% | 55% | 53% | 20% |
- Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificy and false-positive results, whereas the Gastroccult test was very accurate[5].
Contraindications
- Avoid gastric lavage in patients with suspected perforated abdominal viscus.
Complicatiions
Complications of the procedure include:
- Bleeding from trauma during tube passage in patients with coagulopathy is a possible complication.
- Other rare complications include
- Pharyngeal and esophageal perforation
- Cardiac arrest
- Ethmoid sinus fracture with brain trauma
- Bronchial intubation.
Upper GI Endoscopy
- Upper GI Endoscopy is considered investigation of choice for diagnosing and assessing the source of UGIB.[3][4][5]
- The American Society of Gastrointestinal Endoscopy guidelines recommend that upper gastrointestinal endoscopy be performed within 24 hours of presentation in all patients with UGIB
Indications
- Active UGIB
- Used for biopsy lesions for tissue diagnosis and to treat currently bleeding lesions.
Complications
Complications include
- Aspiration
- Esophageal perforation
- Cardiopulmonary complications secondary to anesthesia
- Increased bleeding while attempting therapeutic intervention
| If upper GI Endoscopy undiagnostic[6] | |||||||||||||||||||||||||
| Patient’s hemodynamic stability | |||||||||||||||||||||||||
| Stable with low volume bleeding | Unstable with large volume bleeding | ||||||||||||||||||||||||
| Repeat endoscopy | Surgery exploration and partial gastrectomy[7] | ||||||||||||||||||||||||
References
- ↑ Pallin DJ, Saltzman JR (2011). "Is nasogastric tube lavage in patients with acute upper GI bleeding indicated or antiquated?". Gastrointest. Endosc. 74 (5): 981–4. doi:10.1016/j.gie.2011.07.007. PMID 22032314.
- ↑ Marshall JB (1982). "Management of acute upper gastrointestinal bleeding". Postgrad Med. 71 (5): 149–54, 157–8. PMID 6978482.
- ↑ Cappell MS, Friedel D (2002). "The role of esophagogastroduodenoscopy in the diagnosis and management of upper gastrointestinal disorders". Med. Clin. North Am. 86 (6): 1165–216. PMID 12510452.
- ↑ Jaskolka JD, Binkhamis S, Prabhudesai V, Chawla TP (2013). "Acute gastrointestinal hemorrhage: radiologic diagnosis and management". Can Assoc Radiol J. 64 (2): 90–100. doi:10.1016/j.carj.2012.08.001. PMID 23245297.
- ↑ Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, Smith J, Jensen ME, Alofaituli G, Gornbein J (2002). "Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots". Gastroenterology. 123 (2): 407–13. PMID 12145792.
- ↑ "Non-variceal upper gastrointestinal haemorrhage: guidelines". Gut. 51 Suppl 4: iv1–6. 2002. PMC 1867732. PMID 12208839.
- ↑ Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002). "Intraoperative endoscopy in laparoscopic colectomy". Surg Endosc. 16 (5): 808–11. doi:10.1007/s00464-001-8226-3. PMID 11997827.