ASGE Annual Postgraduate Course Endoscopy 2022: Breakthrough to Excellence

Christie_GI Bleeding

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In this talk on controlling gastrointestinal (GI) bleeding, Dr. Jennifer Christie discusses the guidelines for managing GI bleeding. The prevalence of GI bleeding is high, with about 500,000 hospitalizations per year and a 70% prevalence of upper GI bleeds. The talk covers the different sources of GI bleeding, including peptic ulcer disease, varices, Mallory Weiss tear, and diverticulosis. <br /><br />Dr. Christie emphasizes the importance of risk stratification and stabilization of the patient's hemodynamics. The Glasgow-Blatchford Score is recommended for risk stratification. A restrictive transfusion approach, with a target hemoglobin level of 7-8 g/dL, is recommended. Endoscopy should be performed within 24 hours of presentation.<br /><br />The use of high-dose proton pump inhibitors (PPIs) for 3 days after endoscopic intervention for peptic ulcer disease is strongly recommended. Repeat endoscopy should be considered if there is evidence of recurrent bleeding. Surgical or interventional radiology intervention may be necessary for high-risk patients with ongoing bleeding.<br /><br />Dr. Christie also discusses the management of small bowel bleeding, including the use of video capsule endoscopy and deep enteroscopy/intra-op enteroscopy.<br /><br />Key take-home points from the talk include the importance of risk stratification, the efficacy of dual endoscopic hemostatic therapy for non-variceal bleeding, the use of hemostatic spray and over-the-scope clips for persistent or recurrent bleeding, and the use of high-dose PPIs after endoscopic intervention. The decision on surgery or transcatheter arterial embolization should be based on patient characteristics if endoscopic intervention is not successful.<br /><br />The talk provides additional references for further information on the topic.

Keywords

gastrointestinal bleeding

GI bleeding

guidelines

prevalence

risk stratification

endoscopy

PPIs

recurrent bleeding

surgical intervention

small bowel bleeding