Endoscopy is performed only if it has been possible to stabilize the patient’s condition and there is the possibility of intensive monitoring. This procedure causes hypoxemia and irritates the vagus nerves; we have witnessed patient-induced cardiac arrest in an unstable state and poor oxygenation. 

Ideally, you, the surgeon, should perform the endoscopy . Unfortunately, for various “political” and financial reasons, in many hospitals, the surgeon does not have access to endoscopy and the corresponding experience. If so, at least be present with her to see and evaluate the findings with your own eyes. Don’t blindly trust gastroenterologists; they will go home soon, leaving you alone with the patient and having trouble identifying the source of the bleeding .  

In order for the result of the study of the stomach to be reliable, the stomach must be prepared for gastroscopy . Insert the thickest nasogastric tube you can find and flush the stomach vigorously and repeatedly to remove as many clots as possible. Usually, a cold saline solution with the addition of vasoconstrictors or without them is used for this purpose, which does not affect the therapeutic value of the method. In addition, regular tap water is just as good, but much cheaper and does not aggravate hypothermia so much. 

With the help of endoscopy, you are trying to visualize the source of bleeding , which can be localized in the esophagus (varicose veins, Mallory-Weiss fissure), stomach (chronic ulcer or superficial erosion), duodenum (ulcer); this source can be single (chronic ulcer) or multiple (erosive gastritis). Pay attention to local manifestations: 

• Active bleeding from the mucosal defect (s). “Visible vessel” “sticking out” in the bottom of the ulcer and indicating recent bleeding and a serious risk of recurrence.  

• A clot fixed at the bottom of the ulcer indicates recent hemorrhage .