Why have controlled trials failed to demonstrate a benefit of esophagogastroduodenoscopy in acute upper gastrointestinal bleeding?

Abstract

Numerous prospective randomized trials have failed to demonstrate a benefit attributable to early diagnostic esophagogastroduodenoscopy (EGD) in acute upper gastrointestinal bleeding (UGIB). The clinical implications of these studies have received extensive editorial comment and analysis. We have employed a probability model to further analyze the reasons why these studies have failed to demonstrate an impact of EGD on UGIB. The clinical course of each bleeding lesion can be predicted from the literature. For each lesion, the mortality associated with early specific intervention afforded by an early specific diagnosis can be compared with the mortality of intervention delayed by applying EGD only to those patients who have a complicated course marked by continued bleeding or rebleeding. Using optimistic assumptions that would tend to overstate the impact of EGD, this analysis estimates the maximum decrease in overall mortality in any of these trials afforded by early diagnostic EGD to be 1.2% which would require randomization of over 5000 patients to demonstrate this benefit in a prospective trial.

Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence

“…553 Complementing these are studies which deal specifically with the diagnosis for GI related cancers. [554][555][556][557][558][559][560][561] Some research was also found on the use of diagnostic procedures (which were largely effective) such as colonoscopy and biopsy, 562 oesophago-gastroduodenoscopy, 563 imaging techniques (for example, computed tomography, ultrasonography, and MR scan), 553 558 push enteroscopy, 564 and molecular-pathological diagnosis. 565 However, there is also evidence which points to the possible complications which may arise during the treatment of patients or due to the procedures mentioned above, or both.…”

Peptische Ulkusblutung*

“…Erst Erickson und Glick [19] Georg Thieme Verlag Stuttgart · New York n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n AKTUELLE CHIRURGIE n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n [46,47].…”

5. Appropriateness of Gastroscopy: Bleeding and Dysphagia 1

“…Several controlled trials in the 1970s and early 1980s com paring outcome in patients with and without endoscopy failed to show an impact on patient outcome [21][22][23][24]. One explanation postulated for this failure to demonstrate the efficacy of diagnostic endoscopy for upper GI bleeding is that identification of the source of bleeding did not have a significant therapeutic impact prior to the introduction of endoscopic hemostatic therapy [25].…”