Seves Isabel, Sousa Conceição, Luz Zaida
Serviço de Gastrenterologia, Hospital de Santo António dos Capuchos, Lisboa.
Acta Med Port. 2002 Nov-Dec;15(6):413-6.
In the setting of upper endoscopy after upper gastrointestinal bleeding (UGIB), the presence of blood or clots in the gastric lumen precluding the complete mucosal examination is a frequent finding.
To define the prognostic value of this endoscopic finding and the need of a follow-up endoscopy.
Retrospective study of 100 consecutive patients with UGIB and the endoscopic finding of blood in the stomach (Group A) and 100 at the same conditions but without this endoscopic finding (Group B). In both groups we compared the bleeding lesions and the presence of clinic, laboratorial and endoscopic signs of severity.
Gastric and duodenal ulcers were the bleeding lesions more frequently identified in both groups. Lesions related to portal hypertension were more frequent in the first than in the second one. There was also a significant association with other endoscopic signs of severe haemorrhage and with the clinical signs of bad prognosis. In the follow-up endoscopy we found new lesions in 46% of the patients in the first group and only in 15% of the second one.
The endoscopic finding of blood or clots in the stomach should be considered as a bad prognostic sign and lead to a second endoscopy.
在上消化道出血（UGIB）后进行上消化道内镜检查时，胃腔内存在血液或血凝块而无法进行完整的黏膜检查是常见的发现。
确定这一内镜检查发现的预后价值以及进行随访内镜检查的必要性。
对100例连续的UGIB患者进行回顾性研究，这些患者内镜检查发现胃内有血液（A组），另100例在相同条件下但无此内镜检查发现（B组）。在两组中，我们比较了出血病变以及临床、实验室和内镜检查的严重程度迹象。
胃溃疡和十二指肠溃疡是两组中最常发现的出血病变。与门静脉高压相关的病变在第一组中比在第二组中更常见。还与其他严重出血的内镜检查迹象以及不良预后的临床迹象存在显著关联。在随访内镜检查中，我们发现第一组46%的患者有新病变，而第二组只有15%的患者有新病变。
胃内有血液或血凝块的内镜检查发现应被视为不良预后迹象，并应进行第二次内镜检查。
