ENDOSCOPIC EVALUTION OF 100 CASES OF GASTRO INTESTINALBLEEDING

VVSM Kumar Dontamsetty 1 , Balakrishna N Shetty 2 and Luckshana Perichetla Nandhivarman 3 . 1. Resident, Department Of Surgery K.S.Hegde Medical Academy, Nitte University, Mangalore. 2. Professor, Department Of Surgery K.S.Hegde Medical Academy, Nitte University, Mangalore. 3. undergraduate, Tbilisi state medical university, Georgia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Upper gastrointenstinal bleeding(UGIB) is one of the surgical emergencies 1 .The etiological spectrum of gastrointenstinal bleeding is diverse and variable from one geographical area to another. Earlier barium meal used for study of UGIB which has its own drawbacks . Now upper GI scopy used as diagnostic too 2 l. Aims And Objectives:-Study the endoscopic evalution and management of upper gastrointestinal bleeding in our college(ks hegde hosiptal) Methods:-A cross sectional study of 100 cases of upper GI bleeding who are admitted in justice K S Hedge Charitable Trust between October 2014 to October 2016 Results:-A Total of 100 patients who underwent upper GI scopy during the period. The patients range in age from 18 to 80, Mean age is 50.5 years .Median 52 years.Out of 100 patients lesions found in 95% patients. Majority of patients are presented with haemtemesis (76%) .Oesophageal varices secondary to alcoholic cirrhosis of liver were the most frequent cause of upper GI bleeding followed by PUD. Cirrhosis is the main etiological factor of upper GI bleed in this study (p value -0.0001) . Esophagus is the most common site of bleeding in this study.In the present study, endoscopic management was the one of the main modality of treatment in 40% of the total patients, consisting of banding (40%). Rest of the patients (57%) were managed conservatively with medical therapy, 3% of the patients were treated surgically. Conclusion:- Endoscopy is essential in the initial evaluation and management of upper gastro intestinal bleeding. In this study UGI endoscopy provided accurate diagnosis in 95% of Patients.  The most common cause of UGI bleeding was oesophageal varices secondary to cirrhosis of liver with portal hypertension. Therapeutic endoscopy was useful in 40% of patients. No complications were encountered during after Endoscopy.  UGI endoscopy serves its best role in the diagnosis of UGI bleeding and in therapeutic

…………………………………………………………………………………………………….... Introduction:-
In modern surgery, Esophago-gastro-duodenoscopy (EGD) is an important tool to visualize the upper part of the gastrointestinal tract up to the duodenum 1 . It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anaesthesia has been used) 3 . Endoscopy is useful in assessing a variety of pathologies. It is used not only as a diagnostic but also a therapeutic tool. Various procedures like variceal band ligation, sclerotherapy, biopsy and hemostasis of bleeders can be achieved in the same sitting. It has indeed become a cost effective and reliable tool to modern surgery.

Method Of Collection Of Data:-
 As soon as the patient is admitted a detailed history regarding nature of bleeding whether it has ceased at the time of admission and the time since the onset will be recorded.  The patients will also be interrogated regarding symptoms of nausea, vomiting, dysphagia, regurgitation, heart burn, abdominal pain, appetite, weight gain or loss and recent changes in bowel habits prior to the bleed.past history of ingestion of drugs over the preceding 48 hrs and frequent ingestion over the preceding months will be enquired about and previous histories of cardiovascular, respiratory, liver diseases will be thoroughly evaluated  habit of consumption of alcohol by the patient  Examination of the abdomen for any area of tenderness, palpable masses, ascites and rectal examination will be carried out.  Based on clinical data obtained a provisional diagnosis will be made.  These patients will be then submitted to oesophagogastro duodenoscopy using a fibreoptic instrument  In this out of 100 cases, 95% patients shows abnormality in endoscopic findings, WHICH IS STATISCALLY HIGHLY SIGNIFICANT COMPARED TO 5% Patients there are no findings found. In this out of 100 patients , endoscopic findings are varices in 48% which is the highest followed by duodenal ulcer (11%) and gastric ulcer(11%) ,Mallory weiss tear seen in 4% , pangastritis in 6% and erosions in 12% and malignancy noted in 3%.  In this out of 100 cases 77 are male and 23 are female. Most common endoscopic finding in male are varices(42%) followed by erosions(8%).
In female most common endoscopic finding is varices(6%) followed by duodenal ulcer(4%).Presence of endoscopic findings are associated with gender .     In this age is ranged between 18-80 years, more number of patients are at range of 51-60 , In that variceal bleed are more in range of 51-60 followed by 31-40 and then 61-70, ulcers are more common in range of 51-60 (10) followed by 41-50. Age association is observed.      In this study out of 100 cases 57 are treated conservatively ,40 are treated by endoscopic banding and gastrectomy in 3 patients, endoscopy not only help in diagnosising but also by its therapeutic role In this study, in total of 100 cases in 48 patients site of bleeding is esophagus ,in that most common cause of bleeding varices 44% and in 36% patients stomach is site of bleeding followed by duodenum 11% In the present study consisting of total 100 patients major were presented with upper GI bleed.In this study males were 77%, whereas females were 23%. The median age was 31-40. In study conducted by Hyasinta Jaka 4 et al majority were males 73% and females 26.6% and median age was 52 years .
In the present study alcohol was commonest precipitating factor for cirrhosis of liver and remained as main etiology of upper GI bleed In this study cirrhosis of liver is main cause of upper GI bleed(P value-0.0001). This study shows the value of endoscopy in upper GI bleed as not only a diagnostic tool but also helped in therapeutic intervention especially in patients with variceal bleed. In the present study, endoscopic management was the one of the main modality of treatment in 40% of the total patients, consisting of banding (40%). Rest of the patients (57%) were managed conservatively with medical therapy, 2% of the patients were treated surgically. whereas, in the study done by Hyasinta Jaka et, al; majority of the patients (60.8%) were treated conservatively and endoscopic and surgical treatments were performed only in 30.8% and 5.8% of cases respectively Most of the non-variceal bleeding in upper GI was amenable to conservative medical management.
This study highlights the value of endoscopy both as a diagnostic and therapeutic tool in the management of all upper GI bleed.
In this study stomach is common site of bleeding followed by esophagus and duodenum., In study made by Libyan 6 esophagus is most common site of bleeding.

Conclusion:-
 Endoscopy is essential in the initial evaluation and management of upper gastro intestinal bleeding.  In this study UGI endoscopy provided accurate diagnosis in 95% of Patients  The most common cause of UGI bleeding was oesophageal varices secondary to cirrhosis of liver . Therapeutic endoscopy was useful in 40% of patients. No complications were encountered during / after Endoscopy.  The most common site of bleeding is stomach in my study  UGI endoscopy serves its best role in the diagnosis of UGI bleeding and in therapeutics.