First Year Fellows Endoscopy Course (August 7 - 8)

7_Upper GI Bleeding

Pdf Summary

Upper GI bleeding is a significant medical problem that requires prompt management. It is defined as any bleeding source proximal to the ligament of Treitz. The goal of initial management is to stabilize the patient's condition and assess the severity of bleeding. Risk stratification tools such as the Glasgow Blatchford score can help determine the need for intervention and the level of care required.<br /><br />Endoscopy plays a crucial role in managing upper GI bleeding. It allows for direct visualization of the bleeding source and the application of hemostatic techniques. Common causes of upper GI bleeding include peptic ulcers, esophageal varices, angiodysplasia, Mallory-Weiss tears, tumors, and Dieulafoy lesions.<br /><br />In the case of antithrombotic use, warfarin can be reversed using prothrombin complex concentrate (PCC) and vitamin K, while aspirin can be resumed after a peptic ulcer bleed for secondary prevention. Acid suppression with proton pump inhibitors (PPIs) is used to decrease the risk of high-risk lesions and to prevent rebleeding after endoscopy.<br /><br />The timing of endoscopy is an important consideration, with early endoscopy within 24 hours of presentation generally recommended. Urgent endoscopy should be performed within 12 hours in cases of variceal bleeding. The presence of endoscopic stigmata, such as active bleeding, visible vessels, adherent clots, or pigmented spots, can help guide the choice of therapeutic interventions.<br /><br />Endoscopic therapies for hemostasis include injection, thermal techniques (heater probe, bipolar probe, argon plasma coagulation), mechanical techniques (hemoclips, over-the-scope clips), and combination therapy. Repeat endoscopy may be necessary for rebleeding cases to ensure permanent control.<br /><br />In conclusion, the management of upper GI bleeding involves initial assessment and risk stratification, medication management, optimization of endoscopic visualization, and the appropriate application of effective and durable hemostatic techniques.

Keywords

Upper GI bleeding

ligament of Treitz

initial management

Glasgow Blatchford score

endoscopy

peptic ulcers

esophageal varices

angiodysplasia

Mallory-Weiss tears

Dieulafoy lesions