Evaluation of upper gastrointestinal endoscopy as a primary investigation in patients with acute upper abdominal pain.

: Fifty-six consecutive patients presenting to one general surgical unit with acute upper abdominal pain were submitted to early diagnostic endoscopy after exclusion of perforation, pancreatitis and gallstone disease. Endoscopy was performed within 48 h of admission in 84% of patients and 68% of the study group were discharged within 48 h of the procedure. In 26 patients a definite causative pathology was identified. In 13 patients there were mucosal changes of doubtful significance, while in 17 patients the examination was normal. Endoscopy in patients admitting to excess alcohol intake was generally unrewarding and there was poor correlation between the clinical diagnosis of peptic ulcer and endoscopic findings. The clinical diagnosis was revised in 64% of patients following endoscopy. The data from this study suggest that early endoscopy in acute upper abdominal pain results in a high yield of positive findings, permits rapid correction of diagnostic errors and facilitates early institution of management and discharge.