Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Endoscopie d’urgence dans l’hémorragie digestive haute

Emergency endoscopy: upper gastrointestinal bleeding

  • 53 Accesses


L’hémorragie digestive haute fait partie des plus grands défis cliniques pour le gastro-entérologue. L’ulcère peptique reste la cause la plus fréquente et la plus significative d’hémorragie digestive haute aiguë, comptant pour environ 50% des cas [1], alors que l’hémorragie due aux varices gastro-œsophagiennes est moins fréquente (5 à 10%) bien que représentant plus souvent un risque vital.


Upper gastrointestinal bleeding are among the greatest clinical challenges for the gastroenterologists. Peptic ulcers remain the commonest and most significant cause of acute upper GI haemorrhage, accounting for about 50% of the cases [1], whereas bleeding from esophagogastric varices is less frequent (5 to 10%) although probably more often lifethreatening.

This is a preview of subscription content, log in to check access.


  1. 1.

    van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, Tytgat GN. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98:1494–9.

  2. 2.

    El-Serag HB, Everhart JE. Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs. Am J Gastroenterol 2000; 95: 3566–73.

  3. 3.

    Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 2003; 98: 653–9.

  4. 4.

    Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–21.

  5. 5.

    Sanders DS, Carter MJ, Goodchap RJ, Cross SS, Gleeson DC, Lobo AJ. Prospective validation of the Rockall risk scoring system for upper GI hemorrhage in subgroups of patients with varices and peptic ulcers. Am J Gastroenterol 2002; 97:630–5.

  6. 6.

    Aljebreen AM, Fallone CA, Barkun AN. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc 2004; 59:172–8.

  7. 7.

    Non-variceal upper gastrointestinal haemorrhage: guidelines. Gut 2002; 51 (Suppl IV): ivl-iv6.

  8. 8.

    Barkun A, Bardou M, Marshall JK and the Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2003; 139: 843–57.

  9. 9.

    Pardo A, Durandez R, Hernandez M, Pizarro A, Hombrados M, Jimenez A, et al. Impact of physician specialty on the cost of nonvariceal upper GI bleeding. Am J Gastroenterol 2002; 97:1535–42.

  10. 10.

    Spiegel BM, Vakil NB, Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393–404.

  11. 11.

    Cipolletta L, Bianco MA, Rotondano G, Marmo R, Piscopo R. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endose 2002; 55:1–5.

  12. 12.

    Jensen DM, Kovacs TO, Jutabha R, Machicado GA, Gralnek IM, Savides TJ, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002; 123: 407–13.

  13. 13.

    Bleau BL, Gostout CJ, Sherman KE, Shaw MJ, Harford WV, Keate RF, et al. Recurrent bleeding from peptic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy. Gastrointest Endose 2002; 56:1–6.

  14. 14.

    Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, et al. The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison. Ann Intern Med. 2003; 139: 237–43.

  15. 15.

    Jalan R, Hayes PC. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. British Society of Gastroenterology. Gut 2000; 46 (Suppl 3-4): 1–15.

  16. 16.

    de Franchis R. Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000; 33: 846–52.

  17. 17.

    Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T. Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 1999; 29:1655–61.

  18. 18.

    Bardou M. Endoscopie approach decreases the risk of rebleeding and death in high-risk peptic ulcer bleeders: a meta-analysis. Endoscopy 2003; 35: 278 [abstract].

  19. 19.

    Bardou M, Youssef M, Toubouti Y, Benhaberou-Brun D, Rahme E, Barkun A. Newer endoscopic therapies decrease both re-bleeding and mortality in high risk patients with acute peptic ulcer bleeding: a series of meta-analyses. Gastroenterology. 2003; 123: A239.

  20. 20.

    Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD. A prospective randomised trial of large versus small-volume endoscopic injection of epinephrine for peptic ulcer bleeding. Gastrointest Endose 2002; 55: 615–19.

  21. 21.

    Laine L, Estrada R. Randomized trial of normal saline solution injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers: is local tamponade enough ? Gastrointest Endose 2002; 55: 6–10.

  22. 22.

    Church NI, Dallai HJ, Masson J, Mowat NA, Johnston DA, Radin E et al. A randomized trial comparing heater probe plus thrombin with heater probe plus placebo for bleeding peptic ulcer. Gastroenterology 2003; 125: 396–403.

  23. 23.

    Cipolletta L, Bianco MA, Rotondano G, Piscopo R, Prisco A, Garofano ML. Prospective comparison of argon plasma coagulator and heater probe in the endoscopic treatment of major peptic ulcer bleeding. Gastrointest Endose 1998; 48:191–5.

  24. 24.

    Chau CH, Siu WT, Law BK, Tang CN, Kwok SY, Luk YW, et al. Randomized controlled trial comparing epinephrine injection plus heat probe coagulation versus epinephrine injection plus argon plasma coagulation for bleeding peptic ulcers. Gastrointest Endose 2003; 57: 455–61.

  25. 25.

    Chou YC, Hsu PI, Lai KH, Lo CC, Chan HH, Lin CP, et al. A prospective randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers. Gastrointest Endose 2003; 57: 324–8.

  26. 26.

    Shimoda R, Iwakiri R, Sakata H, Ogata S, Kikkawa A, Ootani H, et al. Prospective comparison of hemoclips vs ethanol injection and combination of both in bleeding gastric ulcers. Am J Gastroenterol 2003; 98: 2198–2202.

  27. 27.

    Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C. Endoclips vs heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointestinal Endoscopy 2001; 53: 147–51.

  28. 28.

    Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD. A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol 2002; 97: 2250–4.

  29. 29.

    Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology 2004;126:441–50.

  30. 30.

    Burroughs AK, Patch DW. Management of variceal haemorrhage in cirrhotic patients. Gut 2001; 48: 738–40.

  31. 31.

    Banares R, Albillos A, Rincon D, Alonso S, Gonzalez M, Ruiz-del-Arbol L, et al. Endoscopie treatment versus endoscopic plus pharmacologie treatment for acute variceal bleeding: a meta-analysis. Hepatology 2002; 35: 609–15.

  32. 32.

    Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology 2004; 126: 1175–89.

  33. 33.

    Greenwald BD, Caldwell SH, Hespenheide EE, Patrie JT, Williams J, Binmoeller KF, et al. N-2-butyl-cyanoacrylate for bleeding gastric varices: a United States pilot study and cost analysis. Am J Gastroenterol 2003; 98: 1982–8.

  34. 34.

    Cipolletta L, Bianco MA, Rotondano G, Piscopo R, Prisco A, Garofano ML. Emergency endoscopic ligation of actively bleeding gastric varices with a detachable snare. Gastrointest Endose 1998; 47: 400–3.

  35. 35.

    Burak KW, Lee SS, Beck PL. Portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE) syndrome. Gut 2001; 49: 866–72.

  36. 36.

    Garcia N, Sanyal AJ. Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia. Curr Treat Options Gastroenterol 2001; 4:163–71.

  37. 37.

    Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med 2000; 343: 310–6.

  38. 38.

    Gisbert JP, Gonzalez L, Calvet X, Roque M, Gabriel R, Pajares JM. Proton pump inhibitors versus H2-antagonists: a meta-analysis of their efficacy in treating bleeding peptic ulcer. Aliment Pharmacol Ther 2001; 15: 917–26.

  39. 39.

    Lee KK, You JH, Wong IC, Kwong SK, Lau JY, Chan TY. et al. Cost-effectiveness analysis of high-dose omeprazole infusion as adjuvant therapy to endoscopic treatment of bleeding peptic ulcer. Gastrointest Endosc 2003; 57:160–4.

  40. 40.

    Marmo R, Rotondano G, Bianco MA, Piscopo R, Prisco A, Cipolletta L. Outcome of endoscopic treatment for peptic ulcer haemorrhage: is the second look necessary ? A meta-analysis. Gastrointest Endose 2003; 57: 62–7.

  41. 41.

    Chiu PW, Lam CY, Lee SW, Kwong KH, Lam SH, Lee DT, Kwok SP. Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial. Gut 2003; 52:1403–7.

  42. 42.

    Spiegel BM, Ofman JJ, Woods K, Vakil NB. Minimizing recurrent peptic ulcer hemorrhage after endoscopic hemostasis: the cost-effectiveness of competing strategies. Am J Gastroenterol 2003; 98: 86–97.

  43. 43.

    Lau JY, Sung JJ, Lam YH, Chan AC, Ng EK, Lee DW, et al. Endoscopie retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 1999; 340: 751–6.

  44. 44.

    Liu CC, Lee CL, Chan CC, Tu TC, Liao CC, Wu CH, Chen TK. Maintenance treatment is not necessary after Helicobacter pylori eradication and healing of bleeding peptic ulcer: a 5-year prospective, randomized, controlled study. Arch Intern Med 2003; 163: 2020–4.

  45. 45.

    Gisbert JP, Khorrami S, Carballo F, Calvet X, Gene E, Domin-guez-Munoz E. Meta-analysis: Helicobacter pylori eradication therapy vs. antisecretory non-eradication therapy for the prevention of recurrent bleeding from peptic ulcer. Aliment Pharmacol Ther 2004; 19: 617–29.

  46. 46.

    Chan FK, Chung SC, Suen BY, Lee YT, Leung WK, Leung VK, et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med 2001; 344:967–73.

  47. 47.

    Dagher L, Burroughs A. Variceal bleeding and portal hypertensive gastropathy. Eur J Gastroenterol Hepatol 2001; 13: 81–8.

  48. 48.

    Hou MC, Lin HC, Liu TT, Kuo BI, Lee FY, Chang FY, Lee SD. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial. Hepatology 2004; 39: 746–53.

  49. 49.

    Patch D, Sabin CA, Goulis J, Gerunda G, Greenslade L, Merkel C, Burroughs AK. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology 2002; 123: 1013–9.

  50. 50.

    Rubenstein JH, Eisen GM, Inadomi JM. A cost-utility analysis of secondary prophylaxis for variceal haemorrhage. Am J Gastroenterol 2004; 99:1274–88.

  51. 51.

    Cipolletta L, Bianco MA, Rotondano G, Marmo R, Meucci C, Piscopo R. Argon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial. Gastrointest Endose 2002; 56: 467–71.

Download references

Author information

Correspondence to L. Cipolletta.

About this article

Cite this article

Cipolletta, L., Rotondano, G., Bianco, M.A. et al. Endoscopie d’urgence dans l’hémorragie digestive haute. Acta Endosc 34, 663–669 (2004).

Download citation


  • endoscopic
  • hémorragie digestive haute
  • urgence


  • emergency
  • endoscopy
  • upper digestive hemorrhage