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Endoscopic Management of Non-variceal Upper Gastrointestinal Bleeding

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Diagnostic and Therapeutic Procedures in Gastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Acute upper gastrointestinal bleeding (GI bleeding) is a common, potentially life-threatening medical emergency. In the USA, it is estimated that more than 300,000 hospital admissions per year are due to upper GI bleeding, resulting in 30,000 deaths annually (Cappell, Med Clin North Am 92(3):491–509, 2008). Upper GI bleeding is defined as any GI bleeding that occurs in any part of the GI tract proximal to the ligament of Treitz (Lewis et al., Am J Gastroenterol 97:2540–9, 2002). Appropriate patient resuscitation and endoscopic management are important for high-risk stigmata ulcers.

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References

  1. Bianco MA, Rotondano G, Marmo R, Piscopo R, Orsini L, Cipolletta L. Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized controlled trial. Gastrointest Endosc. 2004;60:910–5.

    Article  PubMed  Google Scholar 

  2. Chung SCS, Leung JWC, Leung FW. Effect of submucosal epinephrine injection on local gastric blood flow: a study using laser doppler flowmetry and reflectance spectrophotometry. Dig Dis Sci. 1990;35:1008–11.

    Article  CAS  PubMed  Google Scholar 

  3. Chung SS, Lau JY, Sung JJ, Chan AC, Lai CW, Ng EK, et al. Randomised comparison between adrenaline injection alone or adrenaline injection plus heat probe treatment for actively bleeding ulcers. Br Med J. 1997;314:1307–11.

    Article  CAS  Google Scholar 

  4. Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, et al. Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial. Gastrointest Endosc. 2001;53:147–51.

    Article  CAS  PubMed  Google Scholar 

  5. Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc. 2008;67:422–9.

    Article  PubMed  Google Scholar 

  6. Gevers AM, De Goede E, Simoens M, Hiele M, Rutgeerts P. A randomized trial comparing injection therapy with hemoclip and with injection combined with hemoclip for bleeding ulcers. Gastrointest Endosc. 2002;55:466–9.

    Article  PubMed  Google Scholar 

  7. Jensen DM. Endoscopic control of nonvariceal upper gastrointestinal hemorrhage. In: Yamada T, Alpers DH, Laine L, Owyang C, Powell DW, editors. Textbook of gastroenterology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 2857–79.

    Google Scholar 

  8. Jensen DM, Kovacs TO, Randall GM, et al. Prospective study of thermal coagulation (gold probe) versus combination injection and thermal treatment of high risk patients with severe ulcer or Mallory Weiss bleeding. Gastrointest Endosc. 1994;40:25.

    Google Scholar 

  9. Jensen DM, Kovacs TOG, Jutabha R, Savides T, Cheng S, Jensen ME, et al. Initial results of a multicenter, randomized controlled trial of medical versus combination endoscopic therapy for prevention of recurrent severe ulcer hemorrhage from non-bleeding adherent clots. Gastrointest Endosc. 1996;43:352.

    Article  Google Scholar 

  10. Jutabha R, Jensen DM. Management of severe upper gastrointestinal bleeding in the patient with liver disease. Med Clin North Am. 1996;80:1035–68.

    Article  CAS  PubMed  Google Scholar 

  11. Kaltenbach T, Friedland S, Barro J, Soetikno R. Clipping for upper gastrointestinal bleeding. Am J Gastroenterol. 2006;101:915–8.

    Article  PubMed  Google Scholar 

  12. Laine L, Stein C, Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc. 1996;43:107–10.199.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. Lau JY, Leung WK, Wu JCY, Chan FKL, Wong VWS, Chiu PWY, et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med. 2007;356:1631–40.

    Article  CAS  PubMed  Google Scholar 

  16. Leung JW, Chung SCS. Practical management of nonvariceal upper gastrointestinal bleeding. In: Tytgat GNJ, Classen M, editors. Practice of therapeutic endoscopy. New York: Longman group; 1994. p. 1–16.

    Google Scholar 

  17. Lewis JD, Bilker WB, Farrar JT, Strom BL. Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. Am J Gastroenterol. 2002;97:2540–9.

    Article  PubMed  Google Scholar 

  18. Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD. A prospective, randomized trial of large-versus small-volume endoscopic injection of epinephrine for peptic ulcer bleeding. Gastrointest Endosc. 2002;55:615–9.

    Article  PubMed  Google Scholar 

  19. Lin HJ, Hsieh YH, Tseng GY. A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer disease. Am J Gastroenterol. 2002;97(9):2250–4.

    Article  PubMed  Google Scholar 

  20. Marmo R, Marmo R, Rotondano G, Piscopo R, Bianco MA, D’Angella R, et al. Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials. Am J Gastroenterol. 2007;102:279–89.

    Article  PubMed  Google Scholar 

  21. O’Brien JR. Some effects of adrenaline and anti-adrenaline compounds on platelets in vitro and in vivo. Nature. 1963;200:763–4.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sung JY, Chung SCS, Low JM, Cocks R, Ip SM, Tan P, et al. Systemic absorption of epinephrine after endoscopic submucosal injection in patients with bleeding peptic ulcers. Gastrointest Endosc. 1993;39:20–2.

    Article  CAS  PubMed  Google Scholar 

  24. Swain CP, Storey DW, Bown SG, Heath J, Mills TN, Salmon PR, et al. Nature of the bleeding vessel in recurrently bleeding gastric ulcers. Gastroenterology. 1986;90:595–608.

    Article  CAS  PubMed  Google Scholar 

  25. Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92(3):491–509.

    Article  PubMed  Google Scholar 

  26. Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterology. 1988;95(6):1569–74.

    Article  CAS  PubMed  Google Scholar 

  27. Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345–60. quiz 361

    Article  CAS  PubMed  Google Scholar 

  28. Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc. 2004;59(7):788–94.

    Article  PubMed  Google Scholar 

  29. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356(9238):1318–21.

    Article  CAS  PubMed  Google Scholar 

  30. Cheng DW, Lu YW, Teller T, Sekhon HK, Wu BU. A modified Glasgow Blatchford score improves risk stratification in upper gastrointestinal bleed: a prospective comparison of scoring systems. Aliment Pharmacol Ther. 2012;36(8):782–9.

    Article  CAS  PubMed  Google Scholar 

  31. Saltzman JR, Tabak YP, Hyett BH, Sun X, Travis AC, Johannes RS. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc. 2011;74(6):1215–24.

    Article  PubMed  Google Scholar 

  32. Tsoi KK, Ma TK, Sung JJ. Endoscopy for upper gastrointestinal bleeding: how urgent is it? Nat Rev Gastroenterol Hepatol. 2009;6(8):463–9.https://doi.org/10.1038/nrgastro.2009.108. Epub 2009 Jul 14

    Article  PubMed  Google Scholar 

  33. Lee JG, Turnipseed S, Romano PS, Vigil H, Azari R, Melnikoff N, Hsu R, Kirk D, Sokolove P, Leung JW. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. 1999;50(6):755–61.

    Article  CAS  PubMed  Google Scholar 

  34. Bjorkman DJ, Zaman A, Fennerty MB, Lieberman D, Disario JA, Guest-Warnick G. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc. 2004;60(1):1–8.

    Article  PubMed  Google Scholar 

  35. Lim LG, Ho KY, Chan YH, Teoh PL, Khor CJ, Lim LL, Rajnakova A, Ong TZ, Yeoh KG. Urgent endoscopy is associated with lower mortality in high-risk but not low-risk nonvariceal upper gastrointestinal bleeding. Endoscopy. 2011;43(4):300–6.

    Article  CAS  PubMed  Google Scholar 

  36. Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, Moayyedi P. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;7:CD005415.

    Google Scholar 

  37. Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007;82(3):286–96.

    Article  CAS  PubMed  Google Scholar 

  38. Holster IL, van Beusekom HM, Kuipers EJ, Leebeek FW, de Maat MP, Tjwa ET. Effects of a hemostatic powder hemospray on coagulation and clot formation. Endoscopy. 2015;47(7):638–45.

    Article  PubMed  Google Scholar 

  39. Sulz MC, Frei R, Meyenberger C, Bauerfeind P, Semadeni GM, Gubler C. Routine use of Hemospray for gastrointestinal bleeding: prospective two-center experience in Switzerland. Endoscopy. 2014;46(7):619–24.

    Article  PubMed  Google Scholar 

  40. Yau AH, Ou G, Galorport C, Amar J, Bressler B, Donnellan F, Ko HH, Lam E, Enns RA. Safety and efficacy of Hemospray® in upper gastrointestinal bleeding. Can J Gastroenterol Hepatol. 2014;28(2):72–6.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, 15th Street, Augusta, GA, 30912, USA

    Muhammed Sherid & Subbaramiah Sridhar

  2. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, AD-2226, 1120, 15th Street, Augusta, GA, 30912, USA

    Subbaramiah Sridhar

Authors
  1. Muhammed Sherid
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Correspondence to Subbaramiah Sridhar .

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Editors and Affiliations

  1. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    Subbaramiah Sridhar

  2. Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA

    George Y. Wu

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Sherid, M., Sridhar, S. (2018). Endoscopic Management of Non-variceal Upper Gastrointestinal Bleeding. In: Sridhar, S., Wu, G. (eds) Diagnostic and Therapeutic Procedures in Gastroenterology. Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62993-3_15

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  • DOI: https://doi.org/10.1007/978-3-319-62993-3_15

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-62991-9

  • Online ISBN: 978-3-319-62993-3

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