First Year Fellows Endoscopy Course (August 5 - 6)

7_Upper GI Bleeding

Pdf Summary

Upper gastrointestinal (GI) bleeding is a significant medical problem, with over 250,000 hospital admissions per year and a mortality rate of 2-10%. Endoscopic therapy is the main treatment for GI bleeding, with higher mortality rates if re-bleeding occurs. Initial assessment should include a history of symptoms, signs of bleeding, and evaluation of bleeding volumes and etiologies. Management includes risk stratification, acid suppression before and after endoscopy, and targeting INR levels for patients on warfarin. The Glasgow Blatchford score can help predict the need for intervention and death. Early endoscopy within 24 hours of presentation is recommended for most patients with acute upper GI bleeding. Urgent endoscopy should be performed within 12 hours for variceal bleeding. Tips for visualization during endoscopy include evacuating the stomach, using a therapeutic large channel scope, power irrigation, and patient positioning. Endoscopic therapies include injection, thermal methods (heater probe, bipolar probe, argon plasma coagulation), mechanical methods (hemoclips, OTSC, banding), and combination therapy. Adherent clots may or may not be routinely removed, as meta-analyses have shown conflicting results regarding rebleeding. Patients on aspirin should start aspirin for secondary prevention 1-7 days after bleeding stops. Warfarin can be resumed within 4-7 days after therapeutic EGD. Suspected variceal bleeding should be treated with octreotide and IV antibiotics. Repeat endoscopy may be necessary for rebleeding. The key is to perform an initial assessment while concurrently resuscitating the patient, risk stratify for triage and endoscopy, optimize visualization during endoscopy, and apply effective and durable endoscopic therapy.

Keywords

upper gastrointestinal bleeding

endoscopic therapy

mortality rate

initial assessment

bleeding volumes

acid suppression

INR levels

Glasgow Blatchford score

early endoscopy

variceal bleeding