Via practica 2/2017

Indications for urgent oesophagogastroduodenoscopy and management of these conditions

Indications for urgent oesophagogastroduodenoscopy (EGD) is acute hemorrhage from the upper gastrointestinal tract (GIT) and foreign bodies in the upper GIT. We distinguish variceal bleeding from oesophageal or gastric varices in portal hypertension and nonvariceal which is more frequent. The most common cause of nonvariceal bleeding are peptic ulcers. Management of hemorrhage begins with examination of the patient, assessment of hemodynamic status and intravascular volume replacement with crystalloids and high dose proton pump inhibitors (PPI). The risk stratification of these patients is evaluated by scoring systems that help distinguish the need for hospitalization and timing of EG in the range of less than 12 hours to over 24 hours. Bleeding in portal hypertension requires hospitalization and EGD within 12 hours. Management of bleeding is complicated by an expanding antithrombotic treatment and proper timing to restart the treatment. Small (diameter up to 2 to 2.5 cm and length 5 – 6 cm) non-hazardous (blunt, except for batteries and magnets) foreign bodies do not require EGD. Timing EGD for foreign bodies in the upper GIT depends on their risk, size, complications, range from 2 – 6 hours in oesophageal obstruction to more than 3 – 4 weeks for small non-risk foreign bodies.

Keywords: upper gastrointestinal hemorrhage/bleeding, portal hypertension, oesophageal/portal varices, foreign bodies