GI Bleeding Toolkit | January 2023-GI Bleeding Toolkit

Video Transcription

Video Summary

In this video, a 70-year-old female patient with a history of stroke, Plavix use, and two prior episodes of melanoma presents with melanoma for 12 hours. Initial upper endoscopy during the two prior visits and capsule endoscopy revealed non-bleeding AVMs. On presentation, the patient is hypotensive, tachycardic, and has a hemoglobin level of 8. The next steps involve assessing the patient's stability, transfusion goals, and performing endoscopy based on the suspicion of an obscure source. During endoscopy, there was no significant pathology observed, and colonoscopy revealed evidence of old and fresh blood throughout the colon, but no active bleeding. However, when the terminal ileum was intubated, a lesion causing brisk bleeding was identified. The lesion was a duodenal AVN, and three clips were placed for hemostasis. The importance of not giving up and taking the time to thoroughly examine the gastrointestinal tract was highlighted. It was recommended to consider alternative therapies, such as push endoscopy or bleeding scans, in cases where the source of bleeding is still not identified after thorough examinations and multiple hospitalizations. It was emphasized to be aware of patient-specific factors and tailor the management accordingly, such as adjusting electrocautery settings for different locations. Overall, the key takeaways were to know the available tools and options for managing gastrointestinal bleeding, select the appropriate therapy based on the specific case and lesion characteristics, and confirm that hemostasis is achieved before concluding the procedure.

Keywords

70-year-old female patient

stroke

Plavix use

melanoma

endoscopy

AVMs

bleeding

duodenal AVN

hemostasis

alternative therapies

gastrointestinal bleeding