First Year Fellows Endoscopy Course (August 4-5)

7_Upper GI Bleeding

Pdf Summary

Upper gastrointestinal (GI) bleeding refers to any bleeding that occurs above the ligament of Treitz. It is a significant medical problem, with over 250,000 hospital admissions per year in the United States. The mortality rate is 2-10%, which increases to 3-4 times higher if the patient was already hospitalized for another reason before the bleeding occurred. Most cases of upper GI bleeding stop bleeding spontaneously, but endoscopic therapy is the main treatment for active bleeding. The mortality rate is higher if re-bleeding occurs. <br /><br />Initial management involves assessing the patient's history, signs, bleeding volumes, and possible etiologies. Risk stratification is important for triaging and timing of endoscopy. Various scoring systems are available to predict the need for intervention and death. Acid suppression with proton pump inhibitors (PPIs) is used before and after endoscopy, but it does not decrease re-bleeding, mortality, or the need for surgery. <br /><br />During endoscopy, therapeutic techniques such as injection, thermal therapy (using a heater probe or bipolar probe), mechanical techniques (hemoclips or over-the-scope clips), or combination therapy can be used to stop bleeding. Adherent clots may or may not be removed, as studies have conflicting results regarding re-bleeding risk. <br /><br />In cases of suspected variceal bleeding, octreotide and IV antibiotics are administered. For patients on warfarin, resumption of anticoagulation should occur within 4-7 days after therapeutic endoscopy to reduce the risk of thrombosis. <br /><br />In conclusion, the initial management of upper GI bleeding involves risk stratification, acid suppression, and effective endoscopic therapy. Prompt assessment and treatment are crucial to improve patient outcomes.

Keywords

Upper gastrointestinal bleeding

ligament of Treitz

medical problem

hospital admissions

mortality rate

endoscopic therapy

re-bleeding

risk stratification

proton pump inhibitors

therapeutic techniques