Question
Which one of the following is the investigation of choice in a patient with haematemesis?
The correct answer is
Flexible upper gastrointestinal endoscopy
Investigation of Choice for Haematemesis
Haematemesis, defined as vomiting blood, requires prompt diagnostic evaluation to identify the source of bleeding. The investigation offering the most direct visualization and potential for immediate therapeutic intervention is preferred.
Why Flexible Upper Gastrointestinal Endoscopy?
- Direct Visualization: Allows direct inspection of the esophagus, stomach, and duodenum, the common sites for upper gastrointestinal bleeding.
- Source Identification: Enables accurate identification of bleeding causes, such as peptic ulcers, esophageal or gastric varices, Mallory-Weiss tears, or gastritis.
- Therapeutic Capability: Facilitates immediate treatment, like clipping bleeding vessels, band ligation of varices, or thermal coagulation, directly during the procedure.
Evaluation of Other Options
- Barium Meal: Primarily an imaging study; it lacks therapeutic capability and is less sensitive than endoscopy in detecting certain mucosal lesions or active bleeding points.
- Contrast Enhanced CT Scan: While useful for detecting masses, perforation, or understanding anatomy, it is not the primary tool for diagnosing the cause of acute upper GI bleeding. It may be used if endoscopy is inconclusive or contraindicated.
- Selective Left Gastric Angiography: This invasive procedure is typically reserved for cases with massive, ongoing bleeding that is unresponsive to initial management or when endoscopy cannot be performed. It helps localize the bleeding site for potential embolization.
Therefore, flexible upper gastrointestinal endoscopy is considered the investigation of choice for patients presenting with haematemesis due to its superior diagnostic and therapeutic advantages.
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