Gastrointestinal Haemorrhage

Abstract

Requests for endoscopy in patients who have suffered a gastrointestinal haemorrhage may constitute up to 10% of the work load of an endoscopy unit. There are many problems relating to offering an urgent service to cope with this work load. Patients may be too ill to move, so that endoscopy may need to be performed away from the endoscopy unit, for example on the patient’s ward, or even in the operating theatre. A special endoscopy set with endoscope, light source and accessories should always be ready to travel to such a situation, where adequate facilities for cleaning the instrument after endoscopy should also be available. Patients will need to be resuscitated and the blood volume restored before endoscopy. Resuscitation may still be in progress during the endoscopy and care must be taken to ensure that it is maintained and not jeopardized. The presence of fresh blood and blood clot in the stomach may make endoscopy difficult and hazardous. Although gastric lavage need not be contemplated routinely, it may be necessary to evacuate the stomach and wash it out with saline via a large bore stomach tube during the endoscopy.