Open AccessThe Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room
Author(s) -
Abd Elrazek Abd Elrazek,
Hamdy Mahfouz,
Khaled Abd Elazeem,
Mohamed Fakhry,
Emad Abd Elrazek,
Mahmoud Foad,
Mohamed Alboraie,
Aly Ragab,
Shazly Baghdady,
Shymaa E. Bilasy,
Khalid M. Salama,
Ramy Abdel Masseih,
Mohamed Amer,
Sayed Hassaneen,
Akshaya Srikanth Bhagavathula,
Asim Ahmed Elnour,
Saif K. Al Nuaimi,
Abdullah Shehab
Publication year - 2015
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000002241
Subject(s) - medicine , esophageal varices , emergency department , upper gastrointestinal bleeding , ascites , portal hypertension , incidence (geometry) , gastroenterology , abdominal pain , varices , cirrhosis , endoscopy , endoscopic ultrasound , general surgery , surgery , physics , psychiatry , optics
In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities. The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients’ priority for UGE. Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB. Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S. Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.