SAME-DAY UPPER AND LOWER ENDOSCOPY IN PATIENTS WITH OCCULT BLEEDING, MELENA, HEMATOCHEZIA, AND OR MICROCYTIC ANEMIA - A RETROSPECTIVE STUDYOF 224 PATIENTS

The purpose of this study was to evaluate the role of same-day upper a nd lower endoscopy in patients investigated for non-acute gastrointest inal bleeding, manifested by occult bleeding, melena, or hematochezia and/or anemia suspected to be caused by gastrointestinal bleeding. A t otal of 224 patients, 127 women and 97 men, were reviewed. A potential bleeding source (PBS) in the upper gastrointestinal tract could have been missed in 25% of the patients if only colonoscopy had been perfor med. In nearly the same proportion of patients (26%) a potential bleed ing source could have been missed if only esophagogastroduodenoscopy h ad been performed. Nine per cent of the patients had a potential bleed ing source in both locations. Forty-six per cent (19 of 41) of the pat ients with a PBS in colon, other than colonic cancer, had a PBS also i n the upper gastrointestinal tract. The chance of finding a potential bleeding source in patients with microcytic anemia and positive Hemocc ult test is threefold higher than for the patients with microcytic ane mia and negative Hemoccult test and twofold higher than in patients wi th normal blood hemoglobin value but positive Hemoccult test. Moreover , 22% (8 of 36) of the patients with microcytic anemia and a positive Hemoccult test had colonic carcinoma. Approximately 30% of the patient s with a PBS had two or more PBSs in one or more organs. Eighteen per cent of 43 patients with a history of upper gastrointestinal symptoms had a PBS in the upper gastrointestinal tract. The corresponding figur e for the patients without a history of upper gastrointestinal symptom s was 29%. We concluded that the value of same-day upper and lower end oscopy is high, particularly in patients with occult bleeding and micr ocytic anemia. The procedure was tolerable and free from significant c omplications even in the elderly. The presence or absence of upper gas trointestinal symptoms does not help in deciding what type of endoscop y should be performed.