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

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).