First Year Fellows Endoscopy Course (July 29 - 30)

7_Upper GI Bleeding

Pdf Summary

Upper gastrointestinal (GI) bleeding is a significant medical problem, with over 250,000 hospital admissions per year. Endoscopic therapy is the main treatment for bleeding, but the mortality rate is higher if re-bleeding occurs. Initial assessment involves obtaining a patient history and assessing signs and symptoms such as hematemesis, melena, and hematochezia. Bleeding volumes and etiologies vary, with peptic ulcers being the most common cause.<br /><br />In cases of warfarin reversal, prothrombin complex concentrate (PCC) and vitamin K administration are recommended, while nonsteroidal anti-inflammatory drugs (NSAIDs) should be stopped. Risk stratification using scoring systems such as Glasgow Blatchford can help determine the need for intervention and outpatient management. Acid suppression with proton pump inhibitors (PPIs) is recommended before and after endoscopy for high-risk lesions.<br /><br />The timing of endoscopy is usually within 24 hours of presentation, although there is debate regarding the optimal timing. Urgent endoscopy is recommended for variceal bleeding but does not show improved outcome for other types of bleeding. Therapeutic techniques during endoscopy include evacuating the stomach, using large channel scopes, power irrigation, and changing patient positions.<br /><br />Various endoscopic stigmata indicate the risk of re-bleeding, with active bleeding having the highest risk. Adherent clots may or may not be removed depending on patient risk. Aspirin can be resumed after peptic ulcer bleeding for secondary prevention. For suspected variceal bleeding, octreotide and IV antibioti

Keywords

Upper gastrointestinal bleeding

Endoscopic therapy

Re-bleeding

Patient history

Hematemesis

Melena

Hematochezia

Peptic ulcers

Warfarin reversal

Prothrombin complex concentrate