Palmer1 in a recent monograph makes a strong plea for a "vigorous" diagnostic approach in the management of patients with upper gastrointestinal hemorrhage. His argument is based on experience with 862 patients. The first 212 patients were not subjected to major diagnostic procedures until bleeding had stopped for several days. The second group, comprising 650 patients, was managed by a bolder regimen.
The argument in favor of the latter is that it is necessary to make a precise diagnosis just as quickly as is possible, and that endoscopic and roentgenologic examinations are neither difficult nor dangerous in a bleeding patient when carried out by a skilled and experienced physician. Such a patient is first treated by ice-water lavage of the stomach, which is designed to control the bleeding; this is followed immediately by esophagogastroscopy and contrast roentgenologic examination.
The results in the second group were superior to those obtained by