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However, based on our 11-year experience of treating hemostasis and upper gastrointestinal bleeding (UGI) in the emergency department, we believe that several points need to be clarified about management of UGI bleeding. The first point is the strategies for initial confirmation of UGI bleeding as well as risk stratification. At present, there are several methods for confirming acute UGI bleeding, such as history taking and notation of the initial presentations, nasogastric tube aspiration, and early endoscopy (within 24 hours after patient admission). Detailed history taking and assessment of clinical symptoms/signs can be done in a timely manner at relatively low cost by experienced emergency medicine physicians. Occasionally, there are cases of patients who have incomplete or unknown history and no obvious hematemesis or melena. In such cases, nasogastric tube aspiration can be performed for determination of UGI bleeding Acute GI bleeding can be confirmed by either fresh blood aspiration (possible active bleed) or coffee ground aspiration (possible no active bleeding). In some situations, however, dry aspiration or a malpositioned tube can lead to misdiagnosis or inconclusive findings. The convenient procedure is with limited utility [2]. The most important procedure for management of patients with UGI bleeding is endoscopy [3,4], and it should be performed by an experienced endoscopist 6 and 24 hours after the patient has been admitted to the emergency department. It can confirm the bleeding status in the UGI tract, and aid in categorizing patients according to the Forrest classification. In regard to capsule video endoscopy, our experience has not shown it to be more beneficial than traditional endoscopy in treatment of upper GI bleeding, though it can be performed by trained emergency department physicians.

What's the Role of Capsule Video Endoscopy in Acute GI Bleeding? and Where it should be