RISK FACTORS FOR MULTIPLE POTENTIALLY BLEEDING LESIONS IN EMERGENCY UPPER GASTROINTESTINAL ENDOSCOPIES.

Introduction. Gastrointestinal bleeding is one of the most important medical-surgical emergencies. Upper gastrointestinal bleeding (UGIB), defined as hemorrhage having its origin above Treitz'angle, is the most frequent type, and is suspected when the patient present with hemethemesis and/or melena. Etiological diagnosis is vital for the patients'prognosis, and it relies mostly on upper gastrointestinal endoscopy (UGIE). However, endoscopy can show more than one bleeding or potentially bleeding lesion. Aim. The objective of our study was to analyze the frequence of multiple potentially bleeding lesions as seen in emergencies upper gastrointestinal endoscopies. Material and Methods. We performed a retrospective study on patients with acute UGIB presented in the Emergency Department of „St. Spiridon" Clinical County Hospital, investigated by UGIE, in the last six months; epidemiological, clinical and biologic data were recorded, as well as the results of UGIE. Furthermore, correlations between the presence of multiple potentially bleeding lesions and clinical and biological factors were made. Results. 480 patients with suspected acute UGIB were investigated by emergency UGIE. The bleeding source was found in 375 (78%) patients; among them, 278 (58%) patients had one single bleeding lesion, while in 97 (14%) patients more than one potentially bleeding lesion was found. For the remaining 105 (22%) patients, no obvious causal lesion were found, and they were further investigated. The most frequent unique lesions were peptic ulcers and gastro-oesophageal varices, while the most encountered associations were Mallory-Weiss syndrome and peptic ulcer, and gastrooesophageal varices and gastro-duodenal ulcer. The factors correlated with the presence of multiple potentially bleeding lesions were: age, alcohol consumption, the presence of cirrhosis and Charleson comorbidity index. Conclusions. Even if in most cases UGIE is diagnostic for UGIB, there are cases when no lesions are found and also cases with more than one potentially bleeding lesion. Older age, the alcohol consumption, cirrhotic patients and the presence of comorbidities are associated with multiple potentially bleeding lesion. Thorough clinical examination and accurate endoscopic exam are mandatory for the right diagnosis and treatment, to ensure the most favorable patients' outcome. [ABSTRACT FROM AUTHOR]