Emergency endoscopy is a life-saving procedure of tremendous importance. It is a long-standing minimal invasive technique utilized for diagnosis and treatment of gastrointestinal tract diseases. Endoscopy is the most precise and practical method for diagnosing the source of upper gastrointestinal bleeding, grading the lesions induced by ingested caustic substances or removing foreign bodies from the esophagus or the stomach. Controversy exists regarding the timing of endoscopy, defined by the period of time between the patient presentation and performing the endoscopy. Hypothetically, an early endoscopy (generally defined as within 24 hours from presentation) compared with routine endoscopy may translate into an improved patient outcome, because early hemostasis should reduce the quantity of blood loss. Also, there are reasons for worse outcomes with urgent endoscopy: absence of back-up support available at the time of endoscopy (surgery or radiology), emergency endoscopy may be associated with insufficient resuscitation. Regarding caustic ingestions, most authors suggest a delay of only 12 hours and a total wait of no more than 24 hours after ingestion for early assessment and treatment. Endoscopy past 48 hours is discouraged because of progressive wall weakening and increased risk of perforation. Sharp esophageal foreign bodies or complete obstruction of the esophagus should prompt an endoscopy within 2 hours from patient’s presentation. In acute purulent cholangitis, timely performed endoscopic retrograde cholangiopancreatography is a reliable option with increased diagnostic and therapeutic effectiveness and decreased morbidity and mortality rates.
Keywords: emergency, digestive endoscopy, indications.
Clinical Emergency Hospital of Bucharest, Calea Floreasca no. 8, Bucharest, Romania