Problems in localization of bleeding sites and the incidence of varicose rupture in emergency endoscopy.

An investigation was made for problems involved in identification of bleeding sites and the incidences of bleeding from esophageal and gastric varices in emergency endoscopy within 24 hr after overt gastrointestinal bleeding. Varices or ulcers are not always the source of bleeding, and endoscopic examinations should be performed early after the onset of bleeding to make correct identification of the bleeding site. For such purposes, aspiration using endoscopy, washing under direct observation using a teflon tube and changing of body posture were found effective. During the 6 years from 1977, bleeding from the esophageal or gastric varices was detected in 4 cases out of 30 cases of esophageal or gastric varices which had undergone emergency endoscopy for overt bleeding. After June, 1979, when hemostatic measure using pure ethanol was applied actively, bleeding from esophageal or gastric varices was observed in 4 cases (2.5%) out of 160 cases. Results of the present emergency endoscopy revealed that the incidence of rupture of varices was not so high as had been expected conventionally.