First Year Fellows Endoscopy Course (July 30-31)

7_Upper GI Bleeding

Pdf Summary

Upper gastrointestinal (GI) bleeding refers to any bleeding source that is located above the ligament of Treitz. It is a significant medical problem, with over 250,000 hospital admissions per year in the United States. The mortality rate is 2-10%, but this increases to 3-4 times higher if the patient was already hospitalized for another reason before developing upper GI bleeding. Most cases (80%) of upper GI bleeding stop bleeding spontaneously, but endoscopic therapy is the main treatment for active bleeding. The mortality rate is higher if there is a re-bleed.<br /><br />Initial management involves assessing the patient's history, signs, bleeding volumes, and potential etiologies. Risk stratification is important for triaging patients and determining the timing of endoscopy. Different scoring systems, such as the Glasgow Blatchford score, can help predict the need for intervention and the risk of death. Acid suppression with proton pump inhibitors (PPIs) is administered before and after endoscopy to decrease the risk of high-risk lesions, but it does not reduce re-bleeding, mortality, or the need for surgery.<br /><br />During endoscopy, visualization techniques such as evacuating the stomach and using therapeutic large channel scopes, power irrigation, and external suction devices can improve visibility. Different endoscopic therapies, such as injection, thermal (including heater probe and argon plasma coagulation), mechanical (including hemoclips and over-the-scope clips), and combination therapies, are used to treat active bleeding or high-risk stigmata. For variceal bleeding, octreotide and IV antibiotics are also administered.<br /><br />The timing of endoscopy is recommended within 24 hours of presentation for most patients with acute upper GI bleeding. Urgent endoscopy (<12 hours) is recommended after hemodynamic resuscitation and stabilization, especially for variceal bleeding. The decision to perform prophylactic endotracheal intubation should consider the patient's risk factors.<br /><br />In summary, when managing upper GI bleeding, initial assessment should be done concurrently with resuscitation. Risk stratification and medication management are important, and endoscopic therapy should be applied to achieve effective and durable hemostasis.

Keywords

Upper gastrointestinal bleeding

ligament of Treitz

mortality rate

endoscopic therapy

Glasgow Blatchford score

proton pump inhibitors

endoscopy

variceal bleeding

hemodynamic resuscitation

risk stratification