Abstract

Background: Endoscopy is routinely recommended as a diagnostic procedure in patients presenting with upper gastrointestinal tract bleeding (UGIB). An example being, instances where patients with liver cirrhosis present with UGIB stemming from probable esophageal varices. However, among many contraindication for the procedure, acute ST elevation myocardial infarction is perhaps the most absolute (whose, post-PCI adjuvant pharmaceutical treatment too may result in UGIB). Since comorbidities are common among chronic liver disease patients, instances of such contraindications are becoming common. Objective: This study hopes to assess the efficacy and safety of diagnostic endoscopy v/s non-invasive markers of probable causes of UGIB in patients with a history of liver cirrhosis and acute ST elevation myocardial infarction. Methodology: This retrospective analysis was conducted upon a total of 43 cases presenting with UGIB and a history of liver cirrhosis and acute STEMI to the medical out-patient department of Liaquat University Hospital, Hyderabad. Data was derived from patient files in the hospital record. The data obtained was analyzed using MS. Excel 2017 and SPSS v. 21.0. Results: The safety of non-invasive markers and efficacy of diagnostic endoscopy are gold-standard. And hence the efficacy of the former and safety of the later where in question in this research. Out of the total cases co-presenting with liver cirrhosis and acute STEMI, only 43 had a complete work-up to yield ample information meriting inclusion in this study. 23 of the endoscopically evaluated cases encountered side-effects ranging from mild to severe, while 3 faced eventual mortality. The efficacy neither of the non-invasive markers for diagnosing a probable cause of upper gastro-intestinal bleeding, rose above 50%. Conclusion: Safe and effective predictors (invasive and non-invasive) of probable cause of UGIB must be identified to act as a substitute in cases where diagnostic endoscopy is absolutely contraindicated. Unfortunately neither of the tested markers yielded satisfactory effects, thus more research is needed. Keywords: Upper Gastro-Intestinal Bleeding, Liver Cirrhosis, Acute ST Elevation Myocardial Infarction, iagnostic Endoscopy, Therapeutic Endoscopy and Non-Invasive Markers.

Authors and Affiliations