Routine Early Endoscopy in Upper-Gastrointestinal-Tract Bleeding: A Randomized, Controlled Trial

To determine whether routine early endoscopy is beneficial to patients with upper-gastrointestinal-tract bleeding that ceases during hospitalization, we randomly assigned 206 patients to routine endoscopy (100 patients) or no routine endoscopy (106). Patients in the latter group underwent endoscopy only if recurrent bleeding occurred during hospitalization or if x-ray films disclosed gastric ulcer or suggested neoplasia. All patients were initially treated with an empiric antacid regimen. When the two groups were compared (experimental versus control), there were no significant differences in overall hospital deaths (11 versus eight), recurrence of bleeding (33 versus 32), number of transfusions required to treat recurrent bleeding (mean ±S.E.M, 7.4±1.2 versus 6.3±0.7 units), deaths after recurrent bleeding (eight versus five), or duration of hospital stay. During the 12 months after discharge, there were also no significant differences in frequency of readmission to the hospital, incidence of further gastrointestinal bleeding, number of hemorrhage-related deaths, or frequency of gastrointestinal surgery. We conclude that endoscopy should not be a routine procedure in patients with upper-gastrointestinal-tract bleeding that ceases during treatment. (N Engl J Med. 1981; 304:925–9.) ROUTINE early endoscopy has been advocated for all patients with upper-gastrointestinal-tract bleeding.^1,2 This recommendation has been based on the assumption that an early diagnosis will beneficially influence management. There is little debate over the importance of making a specific diagnosis in patients with continued bleeding despite customary therapeutic procedures and gastric lavage. In such patients a variety of invasive procedures, such as balloon tamponade for bleeding esophageal varices or surgery for bleeding peptic ulcer, may be required. Therefore, rational treatment decisions demand knowledge of the specific source of bleeding. However, in most patients bleeding ceases during treatment regardless of the.