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Observational Study
. 2015 Dec;94(49):e2241.
doi: 10.1097/MD.0000000000002241.

The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room

Abd Elrazek Abd Elrazek  1 , Hamdy Mahfouz, Khaled Abd Elazeem, Mohamed Fakhry, Emad Abd Elrazek, Mahmoud Foad, Mohamed Alboraie, Aly Ragab, Shazly Baghdady, Shymaa E Bilasy, Khaled Salama, Ramy Abdel Masseih, Mohamed Omar Amer, Sayed Hassaneen, Akshaya Srikanth Bhagavathula, Asim Ahmed Elnour, Saif K Al Nuaimi, Abdullah Shehab
Affiliations
Observational Study

The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room

Abd Elrazek Abd Elrazek et al. Medicine (Baltimore). 2015 Dec.

Erratum in

Abstract

In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities.The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients' priority for UGE.Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB.Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S.Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.

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Conflict of interest statement

The authors confirm the following statements: The manuscript is a unique submission and is not being considered for publication by any other source in any medium. Further, the manuscript has not been published, in part or in full, in any form. That there has been no duplicate publication or submission elsewhere of any part of the work (excluding abstracts); That all authors have read and approved the report; and That there were no financial or other relations that could lead to a conflict of interest. The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Rates of UGIB-related diseases in males and females. M = male, F = female, UGIB = upper gastrointestinal bleeding.
FIGURE 2
FIGURE 2
Incidence of ultrasound-detected peptic ulcer, gastritis, and lower end esophagitis in patients assorted by age groups.
FIGURE 3
FIGURE 3
Incidence of ultrasound detected gastrointestinal polyps, stomach cancer, esophageal cancer, portal hypertensive gastropathy, gastric varices, and esophageal varices in patients assorted by age groups.
FIGURE 4
FIGURE 4
Incidence of ultrasound-detected liver cirrhosis, splenomegaly, hepatomegaly, hepatic focal lesion (HFL), and ascites in patients assorted by age groups.
FIGURE 5
FIGURE 5
Prediction of upper gastrointestinal bleeding (UGIB) according to ability of conventional trans-abdominal 2D ultrasound to predict UGIBs.
FIGURE 6
FIGURE 6
Modified flow chart algorithm of sequential steps used by Rapid I, ver.4.6, to predict upper gastrointestinal bleeding (UGIB).
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