Department of Gastroenterology, University of Massachusetts Medical Center, Worcester, MA, 01655, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
Dig Dis Sci. 2018 Dec;63(12):3448-3456. doi: 10.1007/s10620-018-5244-8. Epub 2018 Aug 22.
Location of bleeding can present a diagnostic challenge in patients without hematemesis more so than those with hematemesis.
To describe endoscopic diagnostic yields in both hematemesis and non-hematemesis gastrointestinal bleeding patient populations.
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.
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).
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.
在没有呕血的患者中，出血部位的诊断比有呕血的患者更具挑战性。
描述在呕血和非呕血胃肠道出血患者人群中内镜诊断的效果。
对在一个 12 个月期间因呕血和非呕血入住三级医疗中心急诊科的 343 例连续确定的胃肠道出血患者进行回顾性分析。获得的数据包括症状、诊断病变、具有诊断效果的程序类型以及诊断时间。
呕血组（n=105）平均需要 15.6 小时才能得出诊断，而非呕血组（n=231）则需要 30.0 小时（p=0.005）。在非呕血组中，首次检查的诊断率仅为 53%，而呕血组为 71%（p=0.02）。非呕血组中有 25%的患者需要多次检查，而呕血组中只有 10%（p=0.004）。呕血组的主要食管胃十二指肠镜检查诊断率为 71%，而非呕血组为 50%（p=0.01）。原发性结肠镜检查在非呕血组中诊断率为 54%，作为二级检查的诊断率为 12.5%。非呕血患者的原发性视频胶囊内镜检查诊断率为 79%（n=14），总体诊断率为 70%（n=33）。
非呕血胃肠道出血患者接受多次非诊断性检查，并且诊断时间更长，然后与呕血患者进行比较。非呕血组中视频胶囊内镜的高诊断率表明该设备在这种情况下具有作用，需要进一步研究。
