The current status of emergency endoscopy for gastrointestinal bleeding in our emergency department : The relationship between the color of hematemesis and the course of treatment

• Published in: KANTO Journal of Japanese Association for Acute Medicine Vol. 44; no. 4; pp. 300 - 305
• Main Authors: Ito, Toshitaka, Matsumoto, Tetsuya, Suga, Hiroyasu, Yamada, Fumie, Sato, Ikumi, Tatsuzaki, Ryota, Kojima, Keisuke, Endo, Tomomi, Fujii, Mika, Teshima, Seina, Sato, Yuuna
• Format: Journal Article
• Language: Japanese
• Published: Japanese Association for Acute Medicine of Kanto 28.12.2023; 日本救急医学会関東地方会
• Subjects: emergency endoscopy; gastrointestinal bleeding; hematemesis; prehospital evaluation; 吐・下血; 消化管出血; 病院前評価; 緊急内視鏡
• ISSN: 0287-301X; 2434-2580
• DOI: 10.24697/jaamkanto.44.4_300

Determining the necessity of emergency endoscopy is an important aspect of treating gastrointestinal bleeding in urgent care. The cause of inadmissible cases of hematemesis and melena often results from the lack of applicability of emergency endoscopy, which is also the case at our hospital. The Glasgow Blatchford Score (GBS) and others have been reported as the criteria for determining the indication for emergency endoscopy. However, since the GBS includes Hb, BUN, and other laboratory findings, it is difficult to predetermine the applicability of emergency endoscopy before the arrival of the patient. There are also cases that do not require emergency endoscopy despite hematemesis or melena being the main complaint, and the patient is treated on a standby basis without the need for hemostasis. We examined the possibility of prehospital evaluation and actual treatment by sharing the color of hematemesis and melena with the emergency medical teams. The subjects were 33 patients (18 upper gastrointestinal and 15 lower gastrointestinal) who were assessed for symptoms of gastrointestinal bleeding, mainly hematemesis and/or melena and transferred to our hospital between June 1, 2022, and the end of February 2023. Emergency endoscopy was performed in 12 (66%) out of 18 cases with upper gastrointestinal hemorrhage. While most were Forrest IIa, IIb, or III, without any sign of active bleeding, only 1 (5.5%) was Forrest lb duodenal ulcer where active oozing was observed, requiring emergency hemostasis. For the lower gastrointestinal tract, there were no cases of emergency hemostasis, and the indication for emergency endoscopy seemed to be significantly limited as the procedure took 4-5 hours to perform. Moreover, the color descriptions of hematemesis and melena were highly subjective, suggesting that the color does not necessarily determine the indication for endoscopy. Thus, the majority of patients who were inadmissible for reasons of endoscopic indications could be admitted if hemodynamically stable.