EXPERIENCES WITH THE "VIGOROUS DIAGNOSTIC APPROACH" TO UPPER GASTROINTESTINAL HEMORRHAGE

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Abstract
Patients (85) hospitalized because of serious upper gastrointestinal hemorrhage were evaluated by the "Vigorous Diagnostic Approach". This called for gastric lavage using an Ewald tube and ice water followed immediately by esophagoscopy, in some cases gastroscopy, and then barium contrast upper gastrointestinal x-rays. The initial clinical impression based upon the history, and physical examination was found not to be reliable in all cases in pointing out the exact source of hemorrhage. In 11 of the 85 patients (12.9%), the source of hemorrhage was revealed by the "Vigorous Diagnostic Approach" to be from such unexpected sources that direction of specific therapy at the suspected cause would have been useless or even harmful. Thus, laparotomy was avoided in patients with previously undetected esophageal varices and esophageal balloon tamponade was avoided in patients with cirrhosis who were bleeding from previously undetected ulcers. It is believed that the mortality directly attributable to hemorrhage (4.7%) would have been considerably higher without the "Vigorous Diagnostic Approach".

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