Endoscopy with gastrointestinal bleeding

Bleeding from the upper parts of the digestive tract

Gastrointestinal bleeding is a secondary pathological condition. The most common causes of bleeding from the upper sections of the gastrointestinal tract are chronic gastric or duodenal ulcer. In recent years, the number of patients hospitalized for peptic ulcer has significantly decreased, but the number of patients with bleeding chronic ulcers remains unchanged.

Patients with gastrointestinal bleeding are divided into 2 groups:

1. Patients who have clear clinical manifestations of ongoing gastrointestinal bleeding, which rapidly aggravates the patient's condition. These patients should be examined in the intensive care unit of the surgical hospital, where there is an opportunity to provide assistance right up to the operational one. Restoration of compensatory possibilities should be combined with the survey.
2. Patients who had clinical manifestations at the time of admission, but the condition is not severe and progressively worsens, and gastrointestinal bleeding is recorded based on an anamnesis and at present the life of the patient is not threatened. These patients can be examined in any diagnostic room and in any sequence.

The main causes of gastrointestinal bleeding from the upper gastrointestinal tract

Duodenal ulcer	20-30%
Erosion of the stomach or duodenum	20-30%
Varicose veins of the esophagus and stomach	15-20%
Stomach ulcer	10-20%
The Mallory-Weiss Syndrome	5-10%
Erosive esophagitis	5-10%
Angioma	5-10%

Fibrogastroduodenoscopy is the most sensitive and informative research method for gastrointestinal bleeding. Diagnosis based on clinical data is accurate only in 50% of cases. At a roentgenoscopy of a stomach it is impossible to find out the most part of diseases of a mucous membrane.

The tasks facing the endoscopist.

1. Find out if there is ongoing bleeding or not.
2. Determine the intensity of the existing bleeding: - profuse,
   • moderate,
   • mildly expressed.
3. Determine the cause of bleeding: nosological form and localization.
4. Assess the nature of the source of bleeding: vessels of the mucous membrane, submucosal or muscle layers, bottom or margins (with ulcerative defect).
5. Assess the nature of changes in tissues surrounding the source of bleeding.
6. Determine: whether there is a threat of resumption of bleeding with stopped bleeding.

Classification of gastrointestinal bleeding from the upper parts of the digestive tract.

• I group. At the time of examination, there is a profuse or small degree of marked bleeding.
• Group II. Bleeding is stopped, but there is a clear threat of its resumption.
• III group. At the time of the inspection there is no bleeding and there is no clear threat of its resumption.

Indication for fibroendoscopy is the suspicion or the fact of gastrointestinal bleeding.

Contraindications to fibroendoscopy for gastrointestinal hemorrhage:

1. If the cause of bleeding is established on the basis of a recent study.
2. Technical impossibility of carrying out the research due to existing changes or pathological bends in the esophagus.
3. Patients in the agonal state, when the establishment of the diagnosis does not affect the management tactics of the patient.

When examining patients with gastrointestinal bleeding, only devices with end optics are used.

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