Endoscopic control of upper gastrointestinal bleeding

D. E. Fleischer

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

It has been estimated that gastrointestinal (GI) bleeding occurs in more than 100,000 patients with peptic ulcer disease each year. In 75-80% of the cases, bleeding will be self-limited. A major predictor of persistent or recurrent bleeding is the magnitude of blood loss before the initial evaluation. Endoscopy has an important role in the evaluation of the patient with suspected or presumed upper GI bleeding. Active bleeding at the time of endoscopy correlates with the more likely probability of persistent bleeding, which carries a higher morbidity and mortality. In addition, there has been continued interest in the finding of a visible vessel. Although there is some controversy as to what a visible vessel actually is and how closely observations will agree about its recognition, there is general agreement that is an important endoscopic finding and that it carries a high likelihood of rebleeding. In addition to the finding of a visible vessel, many endosopists feel that ulcers found in the posterior-inferior wall of the duodenal bulb and high on the lesser curve of the stomach should be considered in a separate category. Owing to their proximity to large vessels, some feel that endoscopic management carries a greater risk because of the possibility of inducing bleeding. A wide variety of endoscopic approaches are available for the therapy of upper GI bleeding. It is convenient to divide these therapies into four categories (a) topical, (b) injection, (c) mechanical, and (d) thermal. Endoscopic therapy for bleeding ulcers has generally been performed with a high degree of safety. The risk of perforation has been about 1%, but the risk of precipitating bleeding with therapy in some series has been as high as 20%. Fortunately, such bleeding can often be controlled by the same hemostatic device. If active bleeding from an ulcer is seen at endoscopy, endoscopic therapy should be delivered at that time. Therapy with multipolar electrocoagulation, heater probe, laser, or injection therapy can all be used with expectations of a high degree of success, the choice resting with the physician. The management of a visible vessel is less certain. Since most physicians place the rebleeding rate at 50%, there are good grounds for initiating treatment whenever a visible vessel is found in the setting of recent bleeding. However, some wait until rebleeding occurs before initiating treatment.

Original languageEnglish (US)
JournalJournal of Clinical Gastroenterology
Volume12
Issue numberSUPPL. 2
StatePublished - 1990
Externally publishedYes

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Keywords

  • bipolar electrocoagulation
  • bleeding
  • endoscopy
  • heater probe
  • laser therapy
  • peptic ulcer disease
  • thermal modalities
  • topical therapy
  • visible vessel

ASJC Scopus subject areas

  • Gastroenterology

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