scholarly journals Routine Second-Look Endoscopy: Ineffective, Costly, and Potentially Misleading

2004 ◽  
Vol 18 (6) ◽  
pp. 401-404 ◽  
Author(s):  
Joseph Romagnuolo
Keyword(s):  
High Risk ◽  
Natural History ◽  
Randomized Trials ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Absolute Risk ◽  
Review Of The Literature ◽  
Second Look ◽  
Forrest Classification ◽  
Upper Gastrointestinal

Despite the best medical and endoscopic efforts, some patients with nonvariceal upper gastrointestinal bleeding suffer recurrences. Because high risk stigmata (visible vessels, active bleeders and adherent clots) often persist despite apparently successful initial hemostasis and have a variable natural history, it would seem reasonable to at least consider a routine second look endoscopy. However, a review of the literature revealed six randomized trials that, in aggregate, do not support such a strategy. In fact, a second look does not appear to be effective and is associated with an increased number of procedures, treatment sessions and possibly retreatment-related complications. In addition, the cointerventions in these trials are already out of date and the potential absolute risk reductions are low when a second look is used with intravenous proton pump inhibitors and/or the application of endoscopic hemoclips or combination endoscopic therapy. Finally, the Forrest classification may provide dangerously misleading estimates of prognosis because it is being used out of context. This review critically analyzes routine second look endoscopy.

scholarly journals Management of acute upper gastrointestinal bleeding

BMJ ◽  
2019 ◽  
pp. l536 ◽  
Author(s):  
Adrian J Stanley ◽  
Loren Laine
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Ulcer Bleeding ◽  
Vasoactive Drugs ◽  
Upper Gastrointestinal

Abstract Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

scholarly journals Spots and Clots – Leave Them or Treat Them? Why and How to Treat

1999 ◽  
Vol 13 (5) ◽  
pp. 413-415 ◽  
Author(s):  
Dennis M Jensen
Keyword(s):  
Intensive Care ◽  
Randomized Trials ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Clinical Indication ◽  
Medical Attention ◽  
Level Of Care ◽  
Endoscopic Appearance ◽  
Arterial Bleeding ◽  
Upper Gastrointestinal

The clinical indication for urgent endoscopy with combined diagnosis and treatment is bleeding that is severe enough to seek medical attention. The author uses stigmata of ulcer hemorrhage as a guide to endoscopic therapy. Active arterial bleeding, nonbleeding visible vessels and adherent nonbleeding clots are always treated endoscopically. In randomized trials, patients have demonstrated better outcomes from endoscopic therapies than from medical therapies. Flat spots, grey or black sloughs, and clear ulcer bases are not treated endoscopically. The clinical condition and the endoscopic appearance of the ulcer (ie, stigmata of hemmorrhage) of the patient with upper gastrointestinal bleeding are used to determine the subsequent level of care (discharge, ward or intensive care).

scholarly journals Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy

2018 ◽  
Vol 10 (4) ◽  
pp. 236-241
Author(s):  
Seyed Mohammad Valizadeh Toosi ◽  
Ahmad Reza Elahi Vahed ◽  
Iradj Maleki ◽  
Zohreh Bari
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
High Dose ◽  
Dose Oral ◽  
Upper Gastrointestinal

BACKGROUND Proton pump inhibitors (PPIs) are now widely prescribed for the management of patients with acute upper gastrointestinal bleeding; although its optimal dose and route of administration has remained a controversial issue. The aim of this study was to assess the clinical effectiveness of high dose oral versus intravenous (IV) PPI after successful endoscopic therapy in patients with bleeding peptic ulcer disease. METHODS 178 patients with active upper gastrointestinal bleeding due to a peptic ulcer with stigmata of high risk for re-bleeding entered the study. After successful endoscopic hemostasis, they were randomized to receive either high dose oral pantoprazole (80 mg stat and 80 mg twice daily for 3 days) or high dose intravenous pantoprazole (80 mg IV infusion within 30 minutes and 8 mg per hour for 3 days). After the 3rd day, the patients in both groups received oral pantoprazole 40 mg twice daily for one month. The end points were comparing the rate of re-bleeding or mortality, and the need for blood transfusion or surgery during the first month between the two groups. RESULTS There were not significant statistical differences between the two groups in the volume of blood transfusion, mean duration of hospital stay, need to surgery, or mortality rates. However, the rates of re-bleeding were 2.3% (2:88) in the IV group and 3.3% (3:90) in the oral group (p = 0.6). CONCLUSION According to our findings, it seems that high dose oral PPI can be a good alternative to high dose IV PPI in patients with bleeding peptic ulcer who are at high risk of re-bleeding. Due to the lower cost and the availability of oral PPIs, their use can be economically much more affordable.

Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB)

2016 ◽  
Vol 31 (8) ◽  
pp. 3339-3346
Author(s):  
Jin Woo Choi ◽  
Seong Woo Jeon ◽  
Jung Gu Kwon ◽  
Dong Wook Lee ◽  
Chang Yoon Ha ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
High Risk Patients ◽  
Risk Patients ◽  
Upper Gastrointestinal

scholarly journals Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding

2020 ◽  
Vol 7 (1) ◽  
pp. e000479
Author(s):  
Drew B Schembre ◽  
Robson E Ely ◽  
Janice M Connolly ◽  
Kunjali T Padhya ◽  
Rohit Sharda ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Length Of Stay ◽  
Gastrointestinal Bleeding ◽  
Transfusion Requirement ◽  
Upper Gastrointestinal Bleeding ◽  
Low Risk ◽  
Risk Patients ◽  
Bleeding Score ◽  
Upper Gastrointestinal

ObjectiveThe Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.DesignWe reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death.ResultsOver 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die.ConclusionA semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.

scholarly journals Novel hemostatic adhesive powder for nonvariceal upper gastrointestinal bleeding

2019 ◽  
Vol 07 (12) ◽  
pp. E1763-E1767
Author(s):  
Jin-Seok Park ◽  
Hyung Kil Kim ◽  
Yong Woon Shin ◽  
Kye Sook Kwon ◽  
Don Haeng Lee
Keyword(s):  
Gastrointestinal Bleeding ◽  
Success Rate ◽  
Medical Records ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Bleeding Site ◽  
Success Rates ◽  
Main Study ◽  
Rebleeding Rate ◽  
Upper Gastrointestinal

Abstract Background and study aims A new hemostatic adhesive powder (UI-EWD) was developed to reduce high rebleeding rates and technical challenges associated with application of currently available hemostatic powders. The aim of the current study was to assess performance of UI-EWD for nonvariceal upper gastrointestinal bleeding (NVUGIB). Patients and methods A total of 56 consecutive patients that received UI-EWD monotherapy for endoscopic hemostasis due to NVUGIB were retrospectively reviewed. Main study outcomes were success rates with immediate hemostasis and rebleeding within 30 days. Outcomes were analyzed by reviewing patient medical records. Results Etiologies of bleeding were: post-endoscopic therapy bleeding in 46 (82.1 %), peptic ulcer in 8 (14.3 %), tumor in 1 (1.8 %), and other in 1 (1.8 %). UI-EWD was successfully applied at bleeding site in all cases. The success rate of immediate hemostasis was 96.4 % (54/56), and the 30-day rebleeding rate among patients that achieved immediate hemostasis was 3.7 % (2/54). No adverse event related to use of UI-EWD occurred. Conclusion UI-EWD was found to have a high immediate hemostasis success rate in NVUGIB when used as monotherapy and showed promising results in terms of preventing rebleeding.

scholarly journals Consensus on Control of Risky Nonvariceal Upper Gastrointestinal Bleeding in Taiwan with National Health Insurance

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Bor-Shyang Sheu ◽  
Chun-Ying Wu ◽  
Ming-Shiang Wu ◽  
Cheng-Tang Chiu ◽  
Chun-Che Lin ◽  
...  
Keyword(s):  
Health Insurance ◽  
High Risk ◽  
Gastrointestinal Bleeding ◽  
National Health Insurance ◽  
National Health ◽  
Upper Gastrointestinal Bleeding ◽  
Ulcer Bleeding ◽  
Chronic Obstructive ◽  
Research Database ◽  
Upper Gastrointestinal

Background and Aims. To compose upper gastrointestinal bleeding (UGIB) consensus from a nationwide scale to improve the control of UGIB, especially for the high-risk comorbidity group.Methods. The steering committee defined the consensus scope to cover preendoscopy, endoscopy, postendoscopy, and overview from Taiwan National Health Insurance Research Database (NHIRD) assessments for UGIB. The expert group comprised thirty-two Taiwan experts of UGIB to conduct the consensus conference by a modified Delphi process through two separate iterations to modify the draft statements and to vote anonymously to reach consensus with an agreement ≥80% for each statement and to set the recommendation grade.Results. The consensus included 17 statements to highlight that patients with comorbidities, including liver cirrhosis, end-stage renal disease, probable chronic obstructive pulmonary disease, and diabetes, are at high risk of peptic ulcer bleeding and rebleeding. Special considerations are recommended for such risky patients, including raising hematocrit to 30% in uremia or acute myocardial infarction, aggressive acid secretory control in high Rockall scores, monitoring delayed rebleeding in uremia or cirrhosis, considering cycloxygenase-2 inhibitors plus PPI for pain control, and early resumption of antiplatelets plus PPI in coronary artery disease or stroke.Conclusions. The consensus comprises recommendations to improve care of UGIB, especially for high-risk comorbidities.

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