Diagnostic and therapeutic endoscopy.

Endoscopic therapy improves the outcome of nonvariceal upper gastrointestinal hemorrhage. Routine second-look procedures may not improve outcome. Patients who rebleed after endoscopic therapy for ulcer hemorrhage should be treated by further endoscopic therapy, rather than urgent surgery. Thinner endoscopes offer adequate visualization with improved patient tolerance, and new endoscopic therapeutic methods continue to be evaluated. Stigmata of recent hemorrhage and their endoscopic interpretation remain a topic for discussion. The Rockall scoring system is validated. Percutaneous endoscopic gastrostomy insertion may be possible without prior transillumination of the stomach. Routine use of antibiotics prior to insertion reduces wound infection. Percutaneous endoscopic gastrostomy feeding is well established, and follow-up studies confirm its value. Endoscopic ultrasound is a rapidly developing technique. Its uses and potential have evolved, resulting in wider applications in benign disease of the esophagus, biliary tree, and pancreas, in addition to its increasing role in the diagnosis and staging of malignancy.