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

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    Authors
    Jawaid, Salmaan
    Marya, Neil B.
    Gondal, Bilal
    Maranda, Louise S.
    Marshall, Christopher
    Charpentier, Joseph
    Rupawala, Abbas
    Al-Sayid, Muhammad
    Singh, Anupam
    Foley, Anne
    Volturo, Gregory A.
    Cave, David R.
    Show allShow less
    UMass Chan Affiliations
    Department of Emergency Medicine
    Department of Quantitative Health Sciences
    Department of Medicine, Division of Gastroenterology
    Document Type
    Journal Article
    Publication Date
    2018-12-01
    Keywords
    Diagnostic yield
    Endoscopy
    Gastrointestinal hemorrhage
    Video capsule endoscopy
    Diagnosis
    Digestive System Diseases
    Emergency Medicine
    Fluids and Secretions
    Gastroenterology
    Pathological Conditions, Signs and Symptoms
    
    Metadata
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    Link to Full Text
    https://doi.org/10.1007/s10620-018-5244-8
    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.
    Source

    Dig Dis Sci. 2018 Dec;63(12):3448-3456. doi: 10.1007/s10620-018-5244-8. Epub 2018 Aug 22. Link to article on publisher's site

    DOI
    10.1007/s10620-018-5244-8
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/28471
    PubMed ID
    30136044
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1007/s10620-018-5244-8
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    UMass Chan Faculty and Researcher Publications
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