Timing of endoscopy in gastrointestinal bleeding

Abstract

Background: In gastrointestinal bleeding, a physician often has to make a decision between two possible choices. Endoscopic management of the bleeding could be initiated immediately, or it could be delayed until the patient has become haemodynamically stable or the conditions for a successful endoscopy have otherwise improved.

Objective: The present article serves to present such situations and highlights their characteristic features.

Methods: The choice between immediate and delayed endoscopy is analysed in terms of a decision tree, comparing the expected results of the two management alternatives. The decision tree is applied to three different clinical scenarios associated with gastrointestinal bleeding, where performing endoscopy later rather than sooner represents the preferred management option.

Results: The work up of chronic iron-deficient anaemia in patients with serious cardiac problems should be deferred until resolution of their reduced cardiovascular status. It is also recommended that, even in acute bleeding, endoscopy is deferred until the patient has become haemodynamically stable. Lastly, for nonemergency treatment of oesophageal varices bleeding, a long rather than short interval between consecutive banding sessions appears more beneficial.

Conclusions: The results illustrate how to use threshold analysis as a simple bedside tool to solve seemingly complex decisions associated with management of gastrointestinal bleeding.

Keywords: Decision analysis; gastrointestinal bleeding; gastrointestinal endoscopy; threshold analysis.

Figure 1.

Decision tree of whether to perform endoscopy now or later for a patient with gastrointestinal bleeding.