Guidelines for endoscopic managements of non-variceal upper gastrointestinal bleeding (original) (raw)
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Update on the Endoscopic Management of Peptic Ulcer Bleeding
Current Gastroenterology Reports, 2011
Upper gastrointestinal bleeding is the most common gastrointestinal emergency, with peptic ulcer as the most common cause. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of presentation. Endoscopic therapy is indicated for patients with high-risk stigmata, in particular those with active bleeding and visible vessels. The role of endoscopic therapy for ulcers with adherent clots remains to be elucidated. Ablative or mechanical therapies are superior to epinephrine injection alone in terms of prevention of rebleeding. The application of an ulcer-covering hemospray is a new promising tool. High dose proton pump inhibitors should be administered intravenously for 72 h after endoscopy in high-risk patients. Helicobacter pylori should be tested for in all patients with peptic ulcer bleeding and eradicated if positive. These recommendations have been captured in a recent international guideline.
Diagnosis and Management of Upper Gastrointestinal Bleeding
Am Fam Physician, 2012
Upper gastrointestinal bleeding causes significant morbidity and mortality in the United States, and has been associated with increasing nonsteroidal anti-inflammatory drug use and the high prevalence of Helicobacter pylori infection in patients with peptic ulcer bleeding. Rapid assessment and resuscitation should precede the diagnostic evaluation in unstable patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early upper endoscopy (within 24 hours of presentation) is recommended in most patients because it confirms the diagnosis and allows for targeted endoscopic treatment, including epinephrine injection, thermocoagulation, application of clips, and banding. Endoscopic therapy results in reduced morbidity, hospital stays, risk of recurrent bleeding, and need for surgery. Although administration of proton pump inhibitors does not decrease mortality, risk of rebleeding, or need for surgery, it reduces stigmata of recent hemorrhage and the need for endoscopic therapy. Despite successful endoscopic therapy, rebleeding can occur in 10 to 20 percent of patients; a second attempt at endoscopic therapy is recommended in these patients. Arteriography with embolization or surgery may be needed if there is persistent and severe bleeding.
Endoscopic profile and clinical outcome of patients presenting with upper gastrointestinal bleeding
International Journal of Advances in Medicine
Background: Acute upper gastrointestinal bleeding is a common medical emergency with significant mortality. The aim of the present study is to study endoscopic profile and clinical outcome of patients presenting with upper gastrointestinal bleeding in this region. Methods: This prospective observational study carried out on 100 patients admitted with upper gastrointestinal bleeding. All patients included in study underwent upper gastrointestinal endoscopy after initial evaluation and stabilization. Status of study group patients was noted at discharge. Patients were telephonically contacted at day 15 and were asked about rebleed, readmission for gastrointestinal bleed or death of the patient.Results: The mean age of patients was 48.98 ±14.50 years with male to female ratio of 2.57:1. The most common lesions causing UGI bleed were related to portal hypertension (esophageal and gastric varices) and were seen in 67% of patients. Non portal hypertensive lesions causing UGI bleed (pepti...
2008
Acute upper gastrointestinal bleeding remains one of the most frequent and emergent conditions in everyday clinical practice and a challenge for doctors. Peptic ulcer is responsible for more than half of acute upper gastrointestinal bleeding and is the most fre-quent cause of serious non-variceal bleeding. Despite progress in diagnosis and management in these patients, the recurrence of bleeding remains an important problem. Several drugs and endo-scopic techniques, alone or in combination, have been evaluated in many studies and there is presently enough experience in terms of their efficacy. Endoscopic hemostasis is more effective than any other therapeutic intervention in the treatment of patients with non-variceal upper gastrointestinal bleeding. In patients with high risk of rebleeding spots, the combination of endoscopic hemostasis with high dose proton pump inhibitors is the most effective strategy to reduce bleeding recurrences and the need for surgery.
Update on the management of upper gastrointestinal bleeding
BMJ Medicine
Upper gastrointestinal bleeding is a common emergency presentation requiring prompt resuscitation and management. Peptic ulcers are the most common cause of the condition. Thorough initial management with a structured approach is vital with appropriate intravenous fluid resuscitation and use of a restrictive transfusion threshold of 7-8 g/dL. Pre-endoscopic scoring tools enable identification of patients at high risk and at very low risk who might benefit from specific management. Endoscopy should be carried out within 24 h of presentation for patients admitted to hospital, although optimal timing for patients at a higher risk within this period is less clear. Endoscopic treatment of high risk lesions and use of subsequent high dose proton pump inhibitors is a cornerstone of non-variceal bleeding management. Variceal haemorrhage results in higher mortality than non-variceal haemorrhage and, if suspected, antibiotics and vasopressors should be administered urgently, before endoscopy....
Upper gastrointestinal bleeding from the endoscopist’s view
Hellenic Journal of Surgery, 2010
Bleeding from the upper gastrointestinal tract is a frequent cause for emergency hospital admission that concerns both the endoscopist and general surgeon. Regarding the cause, peptic ulcers are the most frequent source of bleeding. Regarding severity, they range from simply a small episode to severe life-threatening hemorrhage. The aim of this article is to present current trends regarding optimal diagnostic work-up and therapeutic procedures for patients with upper gastrointestinal bleeding, especially those with severe haemorrhage, by a comprehensive review of the current literature.
A study of upper gastrointestinal endoscopy in management of acute upper gastrointestinal bleed
International Surgery Journal
Background: Upper gastrointestinal bleeding (UGIB) is life threatening emergency that remains a common cause of hospitalization worldwide. In spite of tremendous advancement in management of upper gastrointestinal bleeding (UGIB) over past two decades, it carries considerable mortality, morbidity. The present study was undertaken to know the clinical profile, endoscopic profile, intervention, outcome and mortality of upper GI bleed.Methods: A total of 110 patients of UGIB were evaluated over a period of 30 months for etiology of UGIB like peptic ulcer, variceal bleeding, gastritis, Barrett’s esophagus and malignancy. Therapeutic Intervention (Band ligation, glue injection, clipping etc.) was done as required on case to case basis.Results: Hematemesis was the most common symptom with 62(56.36%) patients. 85(77.27%) patients were presented during first episode of their bleeding. Esophageal varices 50 (45.45%) was the most common diagnosis and the most common past history was alcohol i...
Internet Journal of Medical Update - EJOURNAL
Upper gastrointestinal bleed is defined as bleeding proximal to the ligament of Treitz. The aim of this study was to know the cause of upper GI bleed, prognosis of the patients and role of upper gastrointestinal endoscopy (UGIE) in the management of upper gastrointestinal bleed (UGIB). A study of 140 cases was carried out in the Shree Krishna Hospital and Pramukh Swami Medical College, Karamsad in India between January 2014 and June 2015. All patients were selected by the detailed history and physical examination. Patients with signs and symptoms suggestive of upper GI bleeding such as hematemesis, melena, blood in the nasogastric tubes, and profuse hematochezia were included in the study. Endoscopy was performed in all patients. Rockall scoring system was used to predict the mortality in patients with upper GI bleeding. We use descriptive statistics for analysis. It was found that upper GI bleed was more common in males than females, and was more prevalent in elderly individuals. The most common symptom was found to be hematemesis followed by abdominal pain. The most common cause was portal hypertension, which has a direct correlation with alcohol addiction. UGIE has both diagnostic as well as therapeutic role in UGIB. This study showed that upper GI bleeding was more common in male patients with the most common cause being portal hypertension. We observed that Mallory-Weiss tear had a particular association with NSAIDs. In our study, the Rockall scoring system was seen to predict the mortality in patients with upper GI bleeding. Endoscopy was both diagnostic and therapeutic and endoscopic variceal ligation (EVL/Glue) was performed for esophageal and/fundic varices and adrenaline injection for peptic ulcer bleeding and Mallory-Weiss tear.
Endoscopic findings in upper gastrointestinal bleeding patients at Tehran’s Taleghani Hospital, Iran
2016
Background: Upper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide and emergency medical condition that may require hospitalization. UGIB also increase the risk of morbidity, mortality and needs a health care resource use. To determine the endoscopic findings in patients with UGIB and its frequency among these patients according to age in Tehran’s Taleghani Hospital is the aim of this study. Materials and Methods: The medical records and endoscopy report of 990 patients were retrospectively analyzed, who underwent endoscopy for UGIB in Tehran’s Taleghani Hospital over a period of 2 years in 2010 to 2012. Results: A total of 990 patients had endoscopy for UGIB which consisted of 594 (60%) males and 396(40%) females. And mean age was 54 years ± 17.2 SD. The commonest cause of UGIB was peptic ulcer disease consisting of 52.2% that includes; duodenal ulcer (26.4%) and gastric ulcer with (19.1%), and then followed by esophageal and gastric varices (19.5%). The ...
Archives of Medical Science, 2010
Introduction: In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding. Material and methods: Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patient's general condition, as well as technical equipment and manual skills of the endoscopy staff. Results: The study confirmed the effectiveness of endoscopic treatment of nonvaricose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%). Conclusions: In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious.