First Year Fellows Endoscopy Course ( August 6-7)

7_Upper GI Bleeding

Pdf Summary

Upper gastrointestinal (GI) bleeding is a common medical problem with significant morbidity and mortality. It is defined as any source of bleeding located proximal to the ligament of Treitz. Each year, there are over 250,000 hospital admissions for upper GI bleeding, with a mortality rate of 2-10%. Endoscopic therapy is the main treatment for stopping bleeding, but re-bleeding can occur and is associated with higher mortality.<br /><br />Initial assessment involves obtaining a thorough history, including medications and risk factors for GI bleeding, and performing a physical examination. Hematemesis and melena are common presenting symptoms. The volume of bleeding and specific etiologies can vary, with peptic ulcers being the most common cause.<br /><br />The timing of endoscopy is an important consideration. Early endoscopy within 24 hours of presentation is generally recommended for most patients with acute upper GI bleeding. Urgent endoscopy (<12 hours) may be indicated for certain cases, such as variceal bleeding. The Glasgow Blatchford score is a useful tool for risk stratification and determining the need for intervention and outpatient management.<br /><br />During endoscopy, various therapeutic techniques can be employed to achieve hemostasis, including injection of epinephrine, thermal therapies (heater probe, bipolar probe, argon plasma coagulation), mechanical therapies (hemoclips, over-the-scope clips), and combination therapy.<br /><br />Management of antithrombotic medications, such as warfarin, is crucial in patients with upper GI bleeding. Warfarin reversal with prothrombin complex concentrate (PCC) and vitamin K is recommended, while resumption of anticoagulant therapy should occur within 4-7 days after therapeutic endoscopy.<br /><br />For suspected variceal bleeding, octreotide administration and IV antibiotics are recommended.<br /><br />In conclusion, the initial management of upper GI bleeding involves risk stratification, optimizing endoscopic visualization, and applying effective and durable endoscopic therapy. Prompt diagnosis and appropriate interventions can help improve outcomes in patients with this condition.

Keywords

upper gastrointestinal bleeding

morbidity

mortality

endoscopic therapy

peptic ulcers

Glasgow Blatchford score

hemostasis

antithrombotic medications

warfarin reversal

variceal bleeding