Gastroenterology and Hepatology

Although endoscopy is an established and useful diagnostic tool, its emergency use in acute gastrointestinal tract bleeding has not reduced mortality.¹ However, high-risk groups whose management and ultimate outcome might be influenced favorably by early endoscopy have been identified: patients with visible vessels or fresh blood in ulcer craters (who rebleed at a rate of 58% )² and patients with a history of alcohol abuse or those who rebleed in the hospital after stabilization.³ Emergency colonoscopy, performed after a large-volume purge in patients with acute passage of bloody or maroon stools per rectum, has been very useful. The source of bleeding was established in 88% of these difficult patients, 17% of whom had an upper gastrointestinal tract source.⁴

Advances in therapeutic endoscopy continue. Although there is increasing use of thermal therapy with bipolar electrodes, heater probes, and direct application of laser in gastrointestinal tract bleeding, a consensus