| Summary: | In the l970s, diagnostic fibreoptic endoscopy became part of the
standard practice for evaluation of gastrointestinal disease. In the 1980s, therapeutic
fibreoptic endoscopy is emerging as standard therapy for many gastrointestinal
diseases. As the already sophisticated technology continues to blossom, it
promises to become even more a part of the management of an increasing number
of gastroenterological problems. Endoscopy can provide both a specific diagnosis
as well as an identification of the high risk subgroup of patients with either active
bleeding, or a non bleeding visible vessel that might benefit from endoscopic treatment.
At endoscopy, patients with active ulcer bleeding have either arterial spurting,
oozing or oozing beneath an overlying clot. These have poor outcomes: for
example, when a non bleeding visible vessel is identified, the chances for rebleeding
are approximately 50% during the period of that hospitalization . With an overlying
clot without oozing, where dark spots are noted, there is less than a 10%
chance of rebleeding. There are certain limitations for endoscopic hemostatic
therapy and there are a few bleeding ulcers with an artery too large to expect
endoscopic success. The kind of treatment chosen will be dictated by the availability
of the therapeutic modalities and the skill of the surgeon.
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