Rockall Score Larger Than 7 as a Reliable Criterion for the Selection of Indications for Preventive Transarterial Embolization in a Subgroup of High-Risk Elderly Patients After Primary Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding

A multidisciplinary group of 7 experts developed this update and expansion of the recommendations on the management of acute non-variceal upper gastrointestinal bleeding (NVUGIH) from guidelines published from 2013. The Appraisal of Guidelines for Research and Evaluation (AGREE) process and independent ethics protocols were used. Sources of data included original and published systematic reviews. Recommendations emphasize early risk stratification, by using validated prognostic scales, and early endoscopy (within 24 hours). Endoscopic hemostasis remains indicated for high-risk lesions, whereas data support attempts to dislodge clots with hemostatic, pharmacologic, or combination treatment of the underlying stigmata. Clips or thermo-coagulation, alone or with epinephrine injection, are effective methods. Second-look endoscopy may be useful in selected high-risk patients, but is not routinely recommended. Intravenous high-dose PPI therapy after successful endoscopic hemostasis decreases both rebleeding and mortality in patients with high-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 72 hours after endoscopic hemostasis. For patients with UGIH who require a nonsteroidal anti-inflammatory drug, a PPI is preferred to reduce the rebleeding. Patients with NVUGIH needing secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) again as soon as cardiovascular risks outweigh gastrointestinal risks (usually within 7 days).

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Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding

World Journal of Gastroenterology ◽

10.3748/wjg.v19.i22.3466 ◽

2013 ◽

Vol 19 (22) ◽

pp. 3466 ◽

Cited By ~ 25

Author(s):

Chang-Yuan Wang

Keyword(s):

Elderly Patients ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Acute Upper Gastrointestinal Bleeding ◽

Rockall Score ◽

Upper Gastrointestinal

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Diagnostic and therapeutic value of emergency endoscopy in acute nonvariceal upper gastrointestinal bleeding patients with high-risk Rockall score

World Chinese Journal of Digestology ◽

10.11569/wcjd.v23.i33.5366 ◽

2015 ◽

Vol 23 (33) ◽

pp. 5366

Author(s):

Li-Na Ma

Keyword(s):

High Risk ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Emergency Endoscopy ◽

Therapeutic Value ◽

Rockall Score ◽

Upper Gastrointestinal

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Predictors of Early Rebleeding after Endoscopic Therapy in Patients with Nonvariceal Upper Gastrointestinal Bleeding Secondary to High-Risk Lesions

Canadian Journal of Gastroenterology ◽

10.1155/2013/128760 ◽

2013 ◽

Vol 27 (8) ◽

pp. 454-458 ◽

Cited By ~ 14

Author(s):

Davide Maggio ◽

Alan N Barkun ◽

Myriam Martel ◽

Sara Elouali ◽

Ian M Gralnek ◽

...

Keyword(s):

High Risk ◽

Gastrointestinal Bleeding ◽

Nasogastric Tube ◽

Upper Gastrointestinal Bleeding ◽

National Registry ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

Multivariable Analyses ◽

Upper Gastrointestinal

BACKGROUND: In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) exhibiting high-risk stigmata (HRS) having undergone endoscopic hemostasis are lacking.OBJECTIVES: To determine predictors of early rebleeding, defined as rebleeding before completion of recommended 72 h intravenous proton pump inhibitor infusion postendoscopic hemostasis.METHODS: Data from a national registry of patients with upper gastrointestinal bleeding (the REASON registry) were accessed. Univariable and multivariable analyses were sequentially performed to identify significant independent predictors among a comprehensive list of clinical and laboratory characteristics.RESULTS: Overall, 393 patients underwent endoscopic hemostasis for NVUGIB with HRS. Forty patients rebled ≤72 h thereafter (32.5% female, mean [± SD] age 70.2±11.8 years, 2.88±2.11 comorbidities), while 21 rebled later (38.1% female, mean 70.5±14.1 years of age, 2.62±2.06 comorbidities). Hematemesis or bright red blood per nasogastric tube aspirate was identified as the sole independent significant predictor of early rebleeding versus later among both NVUGIB and, more specifically, patients with peptic ulcer bleeding (OR 7.94 [95% CI 1.80 to 35.01]; P<0.01, and OR 8.41 [95% CI 1.54 to 46.10]; P=0.014, respectively).CONCLUSIONS: When attempting to determine the optimal duration of pharmacotherapy and timing of discharge for patients following endoscopic hemostasis for NVUGIB with HRS, it is noteworthy that individuals who present with hematemesis or bright red blood per nasogastric tube aspirate are at particularly high risk for rebleeding within the first 72 h.

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Over-the-scope clip vs epinephrine with clip for first-line hemostasis in non-variceal upper gastrointestinal bleeding: a propensity score match analysis

Endoscopy International Open ◽

10.1055/a-1005-6401 ◽

2020 ◽

Vol 08 (01) ◽

pp. E50-E58 ◽

Cited By ~ 1

Author(s):

Santi Mangiafico ◽

Flavia Pigò ◽

Helga Bertani ◽

Angelo Caruso ◽

Giuseppe Grande ◽

...

Keyword(s):

High Risk ◽

Mortality Rate ◽

Propensity Score ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Conventional Group ◽

First Line ◽

Over The Scope Clip ◽

Rockall Score ◽

Upper Gastrointestinal

Abstract Background and study aims The over-the-scope clip (OTSC) is a novel tool used to improve the maintenance of hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB); however, studies on the comparison with “conventional” techniques are lacking. In this study, we aimed to compare first-line endoscopic hemostasis achieved using conventional techniques with that achieved using OTSC placement for NVUGIB. Patients and methods From January 2007 to March 2018, 793 consecutive patients underwent upper endoscopy with the hemostasis procedure. Among them, 327 patients were eligible for inclusion (112 patients had OTSC placement and 215 underwent conventional hemostasis). After propensity score matching and adjustment for confounding factors, 84 patients were stratified into the “conventional” group and 84 into the OTSC group. Patient characteristics and outcomes (rebleeding rate, mortality rate within 30 days, and adverse events) were compared between the two groups. Results In the unmatched cohort, hemostasis with OTSC was more frequent in cases of duodenal ulcers with Forrest Ia to IIa and in patients with a higher Rockall score compared with the “conventional group”. In the matched cohort, 93 % of the patients in the “conventional group” underwent hemostasis with epinephrine + through-the-scope clip. Rebleeding events were significantly less frequent in the OTSC group (8 % vs 20 %, 95 %CI 3 – 16 vs 12 – 30; P = 0.02); however, the mortality rate in the two groups was not significantly different (6 % vs 2 %, 95 %CI 1 – 8 vs 2 – 13; P = 0.4). Conclusions OTSC is a safe and effective tool for achieving hemostasis, and we recommend its use as the first-line therapy for lesions with a high risk of rebleeding and in patients with a high risk Rockall score.

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