ASGE Postgraduate Course at ACG: Evidence-based Updates for the Practicing Gastroenterologist | October 2021-Non-variceal Upper GI Bleeding: What You Need to Know in 2021

Video Transcription

Video Summary

In this video, Professor Alan Barkan discusses non-variceal upper GI bleeding and highlights key recommendations from recent guidelines. He explains that non-variceal upper GI bleeding mortality has decreased over the years, with current mortality rates estimated to be around 2%. The cornerstone of therapy is endoscopic hemostasis, and proton pump inhibitors (PPIs) should be considered as adjuvant therapy after successful endoscopic treatment. Barkan discusses the Glasgow-Blatchford score for risk stratification and suggests that patients with a score of 0 or 1 can be safely discharged and scheduled for an elective endoscopy. He recommends a restrictive transfusion policy with a threshold of 7g/dL, aiming for 7-9g/dL. Barkan also discusses the use of erythromycin before endoscopy, timing of endoscopy within 24 hours, and various endoscopic therapies such as bipolar electrocoagulation, heater probes, absolute ethanol injection, through-the-scope clips, argon plasma coagulation, and soft monopolar electrocoagulation. He also mentions the use of hemostatic powders and gels, high-dose PPI therapy, and management in patients who fail endoscopic therapy or experience recurrent bleeding. Barkan emphasizes the importance of performing procedures only in the appropriate clinical setting with adequate support.

Asset Subtitle

Alan N. Barkun, MD, CM, MSc, FASGE

Keywords

non-variceal upper GI bleeding

endoscopic hemostasis

proton pump inhibitors

Glasgow-Blatchford score

endoscopic therapies

high-dose PPI therapy