ASGE guideline: The role of endoscopy in acute non-variceal upper-GI hemorrhage

Douglas G. Adler, Jonathan A. Leighton, Raquel E. Davila, R. David Hambrick, William K. Hirota, Brian C. Jacobson, Waqar A. Quereshi, Elizabeth Rajan, Marc J. Zuckerman, Robert D. Fanelli, Todd Baron, Douglas O. Faigel

Research output: Contribution to journalReview article

180 Scopus citations

Abstract

For the following points: (A), prospective controlled trials; (B), observational studies; (C), expert opinion. • The initial management of UGIB is patient assessment and stabilization with volume resuscitation. (C) • High-risk patients are those with hematemesis, hemodynamic instability, coagulopathy, renal failure, older age, and multiple cormorbidities; these patients require more intensive monitoring. (B) • Antisecretory therapy with PPIs is recommended for patients with bleeding caused by peptic ulcers or in those with suspected peptic ulcer bleeding in whom endoscopy is delayed or unavailable. (A) • Preprocedure erythromycin improves mucosal visibility. (A) • While not part of the routine management of non-variceal UGIB, somatostatin or octreotide can reduce the risk of continued bleeding and the need for surgery but should be viewed as an adjunct to endoscopic and PPI therapy. (A) • Endoscopy is effective in the diagnosis and the treatment of UGIB. (A) • Endoscopic stigmata that predict a high risk of recurrent bleeding in PUD are active spurting, a visible vessel, and an adherent clot; these lesions should be treated. (A) • Patients with low-risk lesions can be considered for outpatient treatment. (A) • Available endoscopic treatment modalities include injection, cautery, and mechanical therapies. (A) • Studies have not demonstrated clear superiority of any one endoscopic treatment modality, although epinephrine injection alone is inferior to combination therapy for peptic ulcer bleeding. (A) • Scheduled repeat endoscopy in patients at high-risk for recurrent bleeding may be beneficial but its role has yet to be defined. (A) • Patients with PUD should be tested and treated for Helicobacter pylori. (A).

Original languageEnglish (US)
Pages (from-to)497-504
Number of pages8
JournalGastrointestinal endoscopy
Volume60
Issue number4
DOIs
StatePublished - Oct 2004

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Adler, D. G., Leighton, J. A., Davila, R. E., David Hambrick, R., Hirota, W. K., Jacobson, B. C., Quereshi, W. A., Rajan, E., Zuckerman, M. J., Fanelli, R. D., Baron, T., & Faigel, D. O. (2004). ASGE guideline: The role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointestinal endoscopy, 60(4), 497-504. https://doi.org/10.1016/s0016-5107(04)01568-8