CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(07): E898-E901
DOI: 10.1055/a-0605-3418
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

When to abandon the search for an elusive gastrointestinal bleeding source

Amnon Sonnenberg
Gastroenterology Section, Portland VA Medical Center, Portland, Oregon, United States
Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, United States
› Author Affiliations
Further Information

Publication History

submitted 29 January 2018

accepted after revision 13 March 2018

Publication Date:
04 July 2018 (online)

Abstract

Background and study aims In some patients with gastrointestinal bleeding, even multiple consecutive endoscopic procedures fail to achieve lasting hemostasis. The current decision analysis was designed to answer the question of when to continue or abandon a sequence of endoscopic attempts of endoscopic hemostasis.

Materials and methods A decision tree with a threshold analysis was used to model the decision between continued endoscopy or expectant management. A low threshold probability was indicative of a preferred management option.

Results For continued endoscopy to be the favored decision, its probability of success in achieving hemostasis needed to exceed the success probability of expectant management by a greater amount than its costs exceeded those of expectant management. Endoscopic attempts at hemostasis should be discontinued if the costs of endoscopy are high compared with those of expectant management. The endoscopic attempt should be continued, if its probability for achieving lasting hemostasis is high.

Conclusions Such principles are applicable as rule of thumb in managing patients with ongoing chronic gastrointestinal bleeding.