Gastrointestinal tract bleeding. Common dilemmas in management.

An accurate diagnosis is the prerequisite in defining gastrointestinal tract bleeding at any level. Flexible endoscopy is the mainstay of diagnosis, and, particularly in the colon, it may be used as a therapeutic tool in conjunction with fulguration. Radionuclide scanning and arteriography have a place in diagnosis when endoscopy fails. The management of variceal bleeding is, in the main, injection sclerotherapy, operation being reserved for patients who rebleed after injection sclerotherapy or in whom a long-term course of sclerotherapy fails. The management of patients with colonic bleeding depends on the accurate pinpointing of bleeding before operation followed by limited excision of the located bleeding site. Some sources of lower gastrointestinal-tract bleeding can be treated by therapeutic endoscopy.