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ASGE Postgraduate Course at ACG: Evidence-based Up ...
Non-variceal Upper GI Bleeding: What You Need to K ...
Non-variceal Upper GI Bleeding: What You Need to Know in 2021
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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
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