Jun Chul Park, MD, from the Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, in Seoul, Korea discusses this article “Factors that affect visibility during endoscopic hemostasis for upper GI bleeding: a prospective study.”
In our study, we attempted to determine the factors that might be associated with endoscopic visibility and used them to create a regression model to predict which patients might have unacceptable visibility before EGD.
Emergency EGD is more difficult than elective EGD because of the presence of luminal blood in the stomach, which interferes with endoscopic visibility.
Most guidelines do not recommend the routine use of erythromycin because there are no additional clinical benefits aside from improving endoscopic visibility and reducing the need for second-look EGDs. Nevertheless, the use of erythromycin is recommended for patients who are suspected of having poor visibility due to the presence of large amounts of blood or clots in their stomachs. Therefore, in the present study, we attempted to determine the factors that might be associated with endoscopic visibility. Based on the results of this study, we hope to develop guidelines on the use of prokinetics before emergency EGD that will assist in improving visibility during endoscopic hemostasis procedures.
We used a classification and regression tree model to facilitate the allocation of the patients to the acceptable visibility group or the unacceptable visibility group. The variables included were the appearance of the nasogastric (NG) tube aspirate and the EGD time. By using this model, patients who had clear NG tube aspirate were allocated to the acceptable visibility group, but if the NG tube aspirate was not clear, selection proceeded to the next step by using the EGD time. If a patient’s EGD time was less than 8.5 hours, they were allocated to the unacceptable visibility group, and patients who had EGD times that were more than 8.5 hours were allocated to the acceptable visibility group. Clinicians can obtain these 2 variables (appearance of the NG tube aspirate and EGD time) relatively easily before they perform emergency endoscopies. We can therefore determine whether prokinetic agents might be useful for improving visibility before emergency endoscopies are performed.
Read the abstract for this article here.
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