First Year Fellows Endoscopy Course (July 28-29)

7_Upper GI Bleeding

Pdf Summary

Upper gastrointestinal (GI) bleeding is a common medical problem that requires immediate attention. It refers to any bleeding that occurs in the upper GI tract, which is located proximal to the ligament of Treitz. This condition leads to over 250,000 hospital admissions each year, with a mortality rate of 2-10%. The main cause of upper GI bleeding is peptic ulcers, followed by esophageal varices, arteriovenous malformations, Mallory-Weiss tears, tumors, and Dieulafoy lesions.<br /><br />Initial management involves a comprehensive assessment to identify the source and severity of the bleeding. Risk stratification tools like the Glasgow Blatchford score can help determine the need for intervention and predict the risk of death. Early endoscopy within 24 hours of presentation is recommended for most patients with acute upper GI bleeding.<br /><br />Once the bleeding source has been identified, endoscopic therapy is the main treatment approach. This may involve various techniques such as injection of epinephrine, placement of hemoclips, thermal therapy (heater probe, bipolar probe, argon plasma coagulation), or mechanical therapy (hemoclips, over-the-scope clip).<br /><br />In cases of suspected variceal bleeding, octreotide is administered to reduce bleeding, and IV antibiotics are prescribed to prevent infection and rebleeding. For patients taking antithrombotic medications, management involves the reversal of warfarin and resumption of anticoagulation therapy within 4-7 days after therapeutic endoscopy.<br /><br />Overall, the key objectives in managing upper GI bleeding are prompt assessment and risk stratification, initiation of appropriate medical therapy, and effective and durable endoscopic therapy. This approach can lead to better outcomes for patients with this condition.

Keywords

Upper gastrointestinal bleeding

GI tract

peptic ulcers

esophageal varices

arteriovenous malformations

Mallory-Weiss tears

Glasgow Blatchford score

early endoscopy

endoscopic therapy

variceal bleeding