ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-GI Bleeding: Comprehensive Management Across the GI Tract

Video Transcription

Video Summary

The transcript reviews assessment and management of gastrointestinal (GI) bleeding across the GI tract, emphasizing triage, endoscopy, hemostasis techniques, and post-procedure care. Bleeding is categorized anatomically: upper GI (proximal to the ligament of Treitz), lower GI (distal to the ileocecal valve), and small-bowel/obscure bleeding (between them).<br /><br />Case 1 highlights a post–Roux-en-Y gastric bypass patient with melena and hemoglobin drop, ultimately found to have a gastrojejunostomy anastomotic ulcer bleed leading to hemorrhagic shock and requiring IR left gastric artery embolization—illustrating how altered anatomy broadens the differential.<br /><br />Initial management prioritizes stabilization (fluids, transfusion target Hgb >7), risk stratification (Glasgow-Blatchford on presentation; Rockall post-endoscopy to predict rebleeding/mortality), and appropriate pharmacotherapy (high-dose IV PPI; ceftriaxone and octreotide when variceal bleed suspected).<br /><br />Case 2 describes profound anemia and melena in a patient on apixaban; EGD revealed a bleeding gastric ulcer later diagnosed as H. pylori–associated gastric adenocarcinoma, underscoring H. pylori testing, eradication confirmation, and follow-up.<br /><br />Small-bowel bleeding workup includes quality EGD/colonoscopy, capsule endoscopy, and deep enteroscopy.<br /><br />Lower GI bleeding is often intermittent (diverticular bleeding common); management includes ruling out upper sources, rapid bowel prep, colonoscopy, CTA, tagged RBC scan, and IR when needed.<br /><br />Endoscopic hemostasis tools reviewed include thermal probes, clips/OTSC, APC for angioectasias, injection therapy, band ligation for varices, and hemostatic powders as temporary control. Anticoagulation reversal and restarting antithrombotics require individualized, multidisciplinary decision-making.

Asset Subtitle

Sarah Kosinski, DNP, APRN, FNP-BC, and John A. Martin, MD, FASGE

Keywords

gastrointestinal bleeding triage

upper GI bleed risk stratification

endoscopic hemostasis techniques

Roux-en-Y anastomotic ulcer bleeding

interventional radiology embolization

small-bowel obscure bleeding workup

lower GI diverticular bleeding management