ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (On-demand)

Das_UGI Bleeding

Pdf Summary

This document summarizes a video case discussion on gastrointestinal (GI) bleeding. The case involves a 60-year-old man with recurrent melena, hemorrhagic shock, and multiple duodenal ulcers. The patient had previously received treatment with TTS endoscopic clip placement during this hospital admission. <br /><br />The repeat esophagogastroduodenoscopy (EGD) revealed clipped ulcers in the duodenal bulb and a 1.5cm ulcer in the second portion of the duodenum. Epinephrine was injected at the ulcer base, leading to slowing of bleeding and mucosal blanching. The classification of the ulcers was determined based on the Forrest classification system. The options for further management were discussed, including repeat bipolar cautery, different catheter sizes, increasing wattage, coagulation grasper, clip placement, TTS, OTSC (over-the-scope clip) based on location, hemostatic powder, and vascular intervention. The risks of rebleeding associated with each option were also presented.<br /><br />The discussion then focused on whether the initial intervention was sufficient or if additional measures were needed. Adjunctive clip placement and the risk of rebleeding were considered. Other aspects of post-bleed management were addressed, including proton pump inhibitor (PPI) use, its duration, route, and frequency, resumption of anticoagulation therapy, timing and route of restarting medications, future nonsteroidal anti-inflammatory drug (NSAID) use, prophylactic use of PPIs, and the approach to rebleeding.<br /><br />Overall, this document provides a brief summary of the video case discussion, describing the patient's presentation, the endoscopic findings, and various management options and considerations.

Keywords

gastrointestinal bleeding

melena

hemorrhagic shock

duodenal ulcers

TTS endoscopic clip placement

esophagogastroduodenoscopy

Forrest classification system

bleeding management

proton pump inhibitor

rebleeding risk