الفهرس 
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Abstract
SUMMARY
Acute upper gastrointestinal bleeding is a common and potentially life threatening with an annual incidence of approximately 90 patients per 100,000 population.
Endoscopic examination of upper gastrointestinal tract is frequently performed to identify the site of hembrrhage in such patient.
In setting of acute upper gastrointestinal bleeding the utility of esophagogastroduodenoscopy is dependent on adequate visualization of the esophagus, stomach and duodenum .
Complete visualization of the stomach by
esophagogastroduodenoscopy is sometimes precluded by retained blood in the stomach (an uncleared fundal pool).
The aim of the study is to define the incidence and to assess the clinical implication of an uncleared fundal pool in patient presenting with acute upper gastrointestinal bleeding.
In addition, different modalities to clear the fundal pool will be compared.
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Our study included 100 patient were admitted to Benha University Hospital (Internal Medicine department) presented by haematemsis, melena or both.
All patients received supportive therapy until vital sign corrected. Emergency endoscopy was done to every patient immediately after received supportive therapy.
Twenty five patients with clear fundal pool is studied as a control group.
Patient of uncleared fundus divided into:
■Nineteen patients of uncleared fundus cleared by using lavage and metoclopramide.
■Twenty five patients fundus cleared by receiving metoclopramide only.
■Thirty one patients fundus cleared by using lavage only.
A second endoscopy was done after clearance the fundus.
The study did show the following results:
1- Incidence of clear fundus by using metoclopramide s 76%.
-Incidence of clear fundus by using metoclopramide and lavage 78.9%.
-The incidence of clear fundus by using lavage only 61.3%.
-The clearance of the fundus is better obtained by using both lavage and metoclapramide than using lavage only.
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2-Incidence of second lesion in follow up endoscopy after clearance the fundus is 43.2%.
3-Highly incidence of second lesion is fundal lesion as fundal extension from esophageal varices, isolated fundal varices. Fundal mass or gastropathy.
4-Most patients of uncleared fundus is hepatitis +ve either B or C and the incidence of variceal lesion with hepatitis B +ve is 33.3 fold than hepatitis B —ye. And incidence of variceal lesion with hepatitis C +ve is 18.06% fold than hepatitis C —ye.
5-most bleeder were around the age of 40 years. This might be due to the high physical and mental activity around this age.
6-Incidence of bleeding with hepatitis C virus is more than incidence of bleeding with hepatitis B virus. Conclusion:
■Fundus must be cleared before endoscopy to obtain good result and consequently to improve the outcome.
■Metoclopromide must be used with lavage to clear the fundus before endoscopy to obtain the good result.
■Good endoscopic follow up to the patient of high risk of bleeding as hepatic patient or patient of history of ulcer specially around the age of forty.