It is a relatively rare patient who can be discharged without having an endoscopy performed. (See the Clinical Pathway .) The role of endoscopy to risk stratify patients has been well-established. If endoscopy cannot be performed promptly, low-risk patients with a nasogastric tube aspirate without evidence of active bleeding may be admitted to a ward bed, an observation unit, or held in the ED until endoscopy can be performed. High-risk patients must be admitted to an ICU or held in the ED until endoscopy can be performed.
After endoscopic evaluation and treatment, a disposition may be made based on these results in consultation with the gastroenterologist who performed the endoscopy.
John L. Westhoff; Kurtis R. Holt
March 1, 2004