Gastrointestinal bleeding.

Gastrointestinal bleeding remains one of the most important emergencies in gastroenterology. Despite this, only about 100 abstracts concerning gastrointestinal bleeding (excluding bleeding complicating endoscopic procedures) were presented at this year's Digestive Disease Week (DDW; 7-10 May 2011; Chicago, Illinois, USA), accounting for less than 2% of all presented lectures and posters. It seems that the number of such abstracts has been decreasing over recent years. This may be due in part to the high level of medical care already achieved, especially in the areas of pharmacotherapy and endoscopic treatment of gastrointestinal bleeding. In this review of gastrointestinal bleeding, priority has been given to large epidemiological studies reflecting "real life," and abstracts dealing more or less directly with endoscopic management.

Even young patients with no alarm symptoms should undergo endoscopy for earlier diagnosis of gastric cancer.

BACKGROUND AND STUDY AIMS: There has been a tendency in recent years to omit endoscopy in dyspeptic patients younger than 45 years with no so-called "alarm symptoms." This study was conducted to test whether this policy might lead to an increased rate of delayed diagnosis of gastric cancer, especially in a population with a high prevalence of the disease. PATIENTS AND METHODS: The study included 860 patients (465 women, 395 men; median age 44) referred for the first time for upper gastrointestinal endoscopy because of suspected upper gastrointestinal pathology, to a secondary referral center between 1983 and 1993. Symptoms were assessed using a special questionnaire prior to endoscopy. The endoscopic diagnosis was always confirmed by histology. RESULTS: Gastric cancer was found in 83 patients (12 early cancers, 71 advanced). Patients with cancer were predominantly male (68 %, compared with 44 % in the no-cancer group; P < 0.001), and significantly older (median age 56, 44 and 42 years for advanced, early cancer, and no cancer, respectively; P < 0.001). As many as 24 % of patients with cancer were aged under 45 years. Symptoms occurring more frequently in the gastric cancer group compared with the no-cancer group were weight loss (11 % vs. 0.1 %; P < 0.001), gastrointestinal bleeding (18 % vs. 8 %; P < 0.001), anorexia (43 % vs. 25 %; P < 0.001), and fatigue (53 % vs. 30 %; P < 0.001). In 27 % of cancer patients none of the above symptoms was observed. No statistical difference was seen for pain, nausea, vomiting, and other symptoms. The mean symptom score (1 point for one symptom) was higher in patients with cancer compared with those without (3.1 vs. 2.4; P < 0.001). The duration score (1 to 4 points for durations of less than 6, less than 12, less than 24, and more than 24 months) was lower (1.3 vs. 1.8; P < 0.001) in cancer patients. In three-quarters of cancer patients the duration of symptoms was shorter than 6 months. CONCLUSIONS: Symptoms suggesting gastric cancer are gastrointestinal bleeding, weight loss, and to a lesser degree anorexia and fatigue. Gastric cancer patients show a greater intensity but shorter duration of symptoms than patients with no cancer. Age and alarm symptoms cannot determine the need for upper gastrointestinal endoscopy, at least in areas of high prevalence of gastric cancer.

Prospective comparison of nasal versus oral insertion of a thin video endoscope in healthy volunteers.

BACKGROUND AND STUDY AIMS: Attempts have been made to improve patient's tolerance of upper gastrointestinal endoscopy and to decrease the need for sedation, using thinner endoscopes and a nasal introduction route. We prospectively compared the oral and nasal routes in volunteers, using a thin prototype video endoscope. METHODS: Ten healthy volunteers underwent two upper gastrointestinal endoscopies in a random order on two different days, with the procedure being carried out by a single experienced endoscopist. Parameters assessed were the tolerance of scope insertion and the assessment of the entire procedure (0-10 scale), the method of insertion preferred by the volunteers, the completeness of the examination (assessed by an independent endoscopist), and the time required for the procedure. RESULTS: In one patient, nasal insertion failed, and she was excluded from further analysis. The insertion of the scope was easier via the oral route, as reflected in a shorter examination time (mean 165 vs. 210 seconds, p = 0.017) and patients' tolerance for the scope insertion (mean score: 8 for oral vs. 4 for nasal route; p = 0.03). On the other hand, gagging occurred more frequently during oral endoscopy (6/9 vs 1/9, p = 0.05). Three of the volunteers in each case preferred the oral or the nasal route, and three were not decided, in case of a repeated endoscopy. Similarly, the overall tolerance for the procedure did not between the two groups. CONCLUSION: Thin-diameter gastroscopes seem to improve patient's tolerance. In this small study in volunteers, nasal introduction showed no overall benefit over oral introduction. Modifications of the scope to achieve better nasal passage are necessary.