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British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1982 Feb 20;284(6315):545–548. doi: 10.1136/bmj.284.6315.545

Outcome of endoscopy and barium radiography for acute upper gastrointestinal bleeding: controlled trial in 1037 patients.

M W Dronfield, M J Langman, M Atkinson, T W Balfour, G D Bell, K D Vellacott, S S Amar, D R Knapp
PMCID: PMC1496165  PMID: 6800536

Abstract

A study was conducted to find whether the higher diagnostic yield of endoscopy compared with barium radiography improves management or survival in patients with acute upper gastrointestinal bleeding. A total of 1037 patients were entered into a randomised study comparing the outcomes after each investigation. The diagnostic yield in patients who underwent endoscopy was 73% (382 of 526 cases) and in those examined by radiography 55% (280 of 511 cases). A fifth of the patients in the radiology group and a tenth of those in the endoscopy group subsequently underwent the alternative investigation; in most cases, however, no additional diagnostic information was obtained. Operation rates were similar in two groups, though patients in the endoscopy group were generally operated on sooner. Mortality rates were also similar in the two groups, though postoperative mortality was higher in the endoscopy group. Endoscopy may be a more accurate means of diagnosis than radiography, but it offers no short-term benefits in management.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allan R., Dykes P. A comparison of routine and selective endoscopy in the management of acute gastrointestinal hemorrhage. Gastrointest Endosc. 1974 May;20(4):154–155. doi: 10.1016/s0016-5107(74)73916-5. [DOI] [PubMed] [Google Scholar]
  2. Allen H. M., Block M. A., Schuman B. M. Gastroduodenal endoscopy. Management of acute upper gastrointestinal hemorrhage. Arch Surg. 1973 Apr;106(4):450–455. doi: 10.1001/archsurg.1973.01350160068011. [DOI] [PubMed] [Google Scholar]
  3. Colin-Jones D. G., Cockel R., Schiller K. F. Current endoscopic practice in the United Kingdom. Clin Gastroenterol. 1978 Sep;7(3):775–786. [PubMed] [Google Scholar]
  4. Cotton P. B., Rosenberg M. T., Waldram R. P., Axon A. T. Early endoscopy of oesophagus, stomach, and duodenal bulb in patients with haematemesis and melaena. Br Med J. 1973 Jun 2;2(5865):505–509. doi: 10.1136/bmj.2.5865.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dronfield M. W., McIllmurray M. B., Ferguson R., Atkinson M., Langman M. J. A prospective, randomised study of endoscopy and radiology in acute upper-gastrointestinal-tract bleeding. Lancet. 1977 Jun 4;1(8023):1167–1169. doi: 10.1016/s0140-6736(77)92713-1. [DOI] [PubMed] [Google Scholar]
  6. Eastwood G. L. Does early endoscopy benefit the patient with active upper gastrointestinal bleeding? Gastroenterology. 1977 Apr;72(4 Pt 1):737–739. [PubMed] [Google Scholar]
  7. Graham D. Y. Limited value of early endoscopy in the management of acute upper gastrointestinal bleeding. Prospective controlled trial. Am J Surg. 1980 Aug;140(2):284–290. doi: 10.1016/0002-9610(80)90023-9. [DOI] [PubMed] [Google Scholar]
  8. Hoare A. M. Comparative study between endoscopy and radiology in acute upper gastrointestinal haemorrhage. Br Med J. 1975 Jan 4;1(5948):27–30. doi: 10.1136/bmj.1.5948.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Keller R. T., Logan G. M., Jr Comparison of emergent endoscopy and upper gastrointestinal series radiography in acute upper gastrointestinal haemorrhage. Gut. 1976 Mar;17(3):180–184. doi: 10.1136/gut.17.3.180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Morris D. W., Levine G. M., Soloway R. D., Miller W. T., Marin G. A. Prospective, randomized study of diagnosis and outcome in acute upper-gastrointestinal bleeding: endoscopy versus conventional radiography. Am J Dig Dis. 1975 Dec;20(12):1103–1109. doi: 10.1007/BF01070752. [DOI] [PubMed] [Google Scholar]
  11. Peterson W. L., Barnett C. C., Smith H. J., Allen M. H., Corbett D. B. Routine early endoscopy in upper-gastrointestinal-tract bleeding: a randomized, controlled trial. N Engl J Med. 1981 Apr 16;304(16):925–929. doi: 10.1056/NEJM198104163041601. [DOI] [PubMed] [Google Scholar]
  12. Sandlow L. J., Becker G. H., Spellberg M. A., Allen H. A., Berg M., Berry L. H., Newman E. A. A prospective randomized study of the management of upper gastrointestinal hemorrhage. Am J Gastroenterol. 1974 Apr;61(4):282–289. [PubMed] [Google Scholar]
  13. Stevenson G. W., Cox R. R., Roberts C. J. Prospective comparison of double-contrast barium meal examination and fibreoptic endoscopy in acute upper gastrointestinal haemorrhage. Br Med J. 1976 Sep 25;2(6038):723–724. doi: 10.1136/bmj.2.6038.723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Waldram R., Davis M., Nunnerley H., Williams R. Emergency endoscopy after gastrointestinal haemorrhage in 50 patients with portal hypertension. Br Med J. 1974 Oct 12;4(5936):94–96. doi: 10.1136/bmj.4.5936.94. [DOI] [PMC free article] [PubMed] [Google Scholar]

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