The Diagnosis of the Site of Upper Gastrointestinal Haemorrhage in Patients with Established Portal Hypertension

Seventy-five endoscopies were performed in 60 patients known to have oesophageal varices presenting with further upper gastrointestinal haemorrhage during the previous 72 hours. A site of active bleeding was found at 50 of 75 examinations (67 percent) including all 21 patients endoscoped within three hours of the last haemorrhage. Variceal bleeding alone was seen in 40 of these 50 examinations (80%) and both varices and mucosal lesions were bleeding in 4 patients; mucosal lesions were an uncommon cause of haemorrhage and only 6 patients were bleeding from these alone. The adult GIF-D2 endoscope was used for 45 examinations. Variceal bleeding was restarted on three occasions and prolonged unconsciousness induced by intravenous diazepam in one patient. In contrast, the paediatric GIF-P endoscope (30 examinations) was easily tolerated with little or no sedation, did not impair diagnostic accuracy and was not associated with any complications.