Q. What is the role of endoscopy in diagnosing and treating hematemesis?

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Answered by Secondmedic Expert

Endoscopy plays a crucial role in both diagnosing and treating hematemesis, which is the act of vomiting blood. Here's how endoscopy is utilized in the evaluation and management of hematemesis:

1. Diagnosis:
- Identification of the Source: Endoscopy, specifically esophagogastroduodenoscopy (EGD), allows healthcare professionals to directly visualize the upper gastrointestinal tract, including the esophagus, stomach, and duodenum. This visualization helps identify the source of bleeding, such as ulcers, esophageal varices, gastritis, or other abnormalities.
- Tissue Biopsy: During endoscopy, tissue samples (biopsies) can be obtained from areas that appear abnormal. These samples are sent to the laboratory for further analysis to determine the cause of the bleeding, assess for infection, inflammation, or malignancy, and guide treatment decisions.

2. Treatment:
- Hemostasis: Endoscopy enables therapeutic interventions to stop or control active bleeding. Various techniques can be employed during endoscopy to achieve hemostasis, including:
- Injection therapy: Substances are injected into the bleeding site to promote clot formation and stop bleeding.
- Thermal therapy: Heat-producing methods, such as argon plasma coagulation or bipolar electrocoagulation, can be used to cauterize or seal the bleeding vessel.
- Mechanical therapy: Clips or bands may be applied to the bleeding site to close off blood vessels and prevent further bleeding.
- Variceal Banding: In cases of esophageal varices, endoscopy is used to perform band ligation, where bands are placed around the varices to reduce the risk of rupture and bleeding.
- Sclerotherapy: Sclerosing agents can be injected into varices to shrink and seal them off.

Endoscopy is often the procedure of choice for diagnosing the cause of hematemesis because of its ability to provide direct visualization and obtain tissue samples. Additionally, it offers a minimally invasive way to treat active bleeding or to prevent recurrent bleeding in the case of varices.

The timing of endoscopy is critical, and it should be performed promptly in cases of hematemesis to identify the source of bleeding and initiate appropriate treatment. It can significantly improve patient outcomes by addressing the underlying cause of the bleeding and preventing further episodes of hematemesis.