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Lower Endoscopic Diagnostic Yields Observed in Non-hematemesis Gastrointestinal Bleeding Patients

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Abstract

Background

Location of bleeding can present a diagnostic challenge in patients without hematemesis more so than those with hematemesis.

Aim

To describe endoscopic diagnostic yields in both hematemesis and non-hematemesis gastrointestinal bleeding patient populations.

Methods

A retrospective analysis on a cohort of 343 consecutively identified gastrointestinal bleeding patients admitted to a tertiary care center emergency department with hematemesis and non-hematemesis over a 12-month period. Data obtained included presenting symptoms, diagnostic lesions, procedure types with diagnostic yields, and hours to diagnosis.

Results

The hematemesis group (n = 105) took on average 15.6 h to reach a diagnosis versus 30.0 h in the non-hematemesis group (n = 231), (p = 0.005). In the non-hematemesis group, the first procedure was diagnostic only 53% of the time versus 71% in the hematemesis group (p = 0.02). 25% of patients in the non-hematemesis group required multiple procedures versus 10% in the hematemesis group (p = 0.004). Diagnostic yield for a primary esophagogastroduodenoscopy was 71% for the hematemesis group versus 50% for the non-hematemesis group (p = 0.01). Primary colonoscopies were diagnostic in 54% of patients and 12.5% as a secondary procedure in the non-hematemesis group. A primary video capsule endoscopy yielded a diagnosis in 79% of non-hematemesis patients (n = 14) and had a 70% overall diagnostic rate (n = 33).

Conclusion

Non-hematemesis gastrointestinal bleeding patients undergo multiple non-diagnostic tests and have longer times to diagnosis and then compared those with hematemesis. The high yield of video capsule endoscopy in the non-hematemesis group suggests a role for this device in this context and warrants further investigation.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, University of Massachusetts Medical Center, Worcester, MA, 01655, USA

    Salmaan Jawaid, Neil Marya, Bilal Gondal, Christopher Marshall, Joseph Charpentier, Abbas Rupawala, Muhammad Al-Sayid, Anupam Singh, Anne Foley & David Cave

  2. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Louise Maranda

  3. Department of Emergency Medicine, University of Massachusetts Medical Center, Worcester, MA, 01655, USA

    Gregory Volturo

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  1. Salmaan Jawaid
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Contributions

SJ was involved in study concept and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and statistical analysis. NM contributed to study concept and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript. BG performed acquisition of data, study concept and design. LM was involved in study concept and design, data analysis and interpretation, and statistical analysis. CM, AS, GV, DC contributed to study concept and design, critical revision of the manuscript for important intellectual content. JC performed study concept and design. MA-S analyzed data. AF performed administrative and drafting of manuscript. The study was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board. A HIPPA waiver was approved by the aforementioned IRB given minimal risk to patient subjects.

Corresponding author

Correspondence to Salmaan Jawaid.

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Conflict of interest

Dr David Cave is a consultant for Olympus USA and Tokyo; he is also a contributor to UptoDate.

Additional information

Core Tip: This study is one of the first to follow the diagnostic course of consecutive patients presenting to the emergency department with GIB. Diagnosing bleeding lesions in patients presenting with hematemesis was found to be efficient with quick diagnostic times. However, those presenting with non-hematemesis bleeding have less efficient evaluations, often needing multiple non-diagnostic procedures with longer times to diagnosis.

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Jawaid, S., Marya, N., Gondal, B. et al. Lower Endoscopic Diagnostic Yields Observed in Non-hematemesis Gastrointestinal Bleeding Patients. Dig Dis Sci 63, 3448–3456 (2018). https://doi.org/10.1007/s10620-018-5244-8

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  • DOI: https://doi.org/10.1007/s10620-018-5244-8

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