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Gastroenterology and Hepatology

Arvydas Vanagunas, MD; J. Donald Ostrow, MD
JAMA. 1986;256(15):2088-2091. doi:10.1001/jama.1986.03380150098027.
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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


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