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

The purpose of this study was to evaluate the role of same-day upper and lower endoscopy in patients investigated for non-acute gastrointestinal bleeding, manifested by occult bleeding, melena, or hematochezia and/or anemia suspected to be caused by gastrointestinal bleeding. A total 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 performed. In nearly the same proportion of patients (26%) a potential bleeding source could have been missed if only esophagogastroduodenoscopy had been performed. Nine per cent of the patients had a potential bleeding source in both locations. Forty-six per cent (19 of 41) of the patients with a PBS in colon, other than colonic cancer, had a PBS also in the upper gastrointestinal tract. The chance of finding a potential bleeding source in patients with microcytic anemia and positive Hemoccult test is threefold higher than for the patients with microcytic anemia and negative Hemoccult test and twofold higher than in patients with 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 patients 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 figure for the patients without a history of upper gastrointestinal symptoms was 29%. We concluded that the value of same-day upper and lower endoscopy is high, particularly in patients with occult bleeding and microcytic anemia. The procedure was tolerable and free from significant complications even in the elderly. The presence or absence of upper gastrointestinal symptoms does not help in deciding what type of endoscopy should be performed.