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'First look' unsedated transnasal esogastroduodenoscopy in patients with upper gastrointestinal bleeding? A prospective evaluation
- Source :
- Clinics and research in hepatology and gastroenterology. 38(2)
- Publication Year :
- 2013
-
Abstract
- Summary Background and aims With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB). Patients and methods One hundred and forty-five consecutive patients (mean age, 66 ± 18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as “first look”. Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed. Results Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant. Conclusions Our results strongly support that “first look” unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.drug_class
Sedation
Hemostatics
law.invention
Young Adult
law
medicine
Humans
Endoscopy, Digestive System
Hospital Mortality
Prospective Studies
Aged
Aged, 80 and over
Aspirin
Hepatology
medicine.diagnostic_test
business.industry
Esophagogastroduodenoscopy
Hemostatic Techniques
Patient Selection
Anticoagulant
Gastroenterology
Anticoagulants
Length of Stay
Middle Aged
Clopidogrel
medicine.disease
Intensive care unit
Endoscopy
Surgery
Cardiovascular Diseases
Anesthesia
Female
Upper gastrointestinal bleeding
medicine.symptom
business
Gastrointestinal Hemorrhage
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 2210741X
- Volume :
- 38
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Clinics and research in hepatology and gastroenterology
- Accession number :
- edsair.doi.dedup.....acd92d5bf97555a18db6c8182a440a85