scholarly journals ENDOSCOPIC TREATMENT FOR UPPER GI BLEEDING. REVALIDATION OF FORREST CLASSIFICATION

2017 ◽  
Vol 64 (2) ◽  
pp. 138-141
Author(s):  
Ahed EL-KHATIB ◽  
◽  
Catalin Alius ◽  
Dragos Serban ◽  
◽  
...  
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Survival Rates ◽  
Comorbid Conditions ◽  
Surgical Interventions ◽  
Tertiary Centre ◽  
Forrest Classification ◽  
High Doses ◽  
Endoscopic Assessment ◽  
Evidence Based Guidelines ◽  
Upper Gastrointestinal

Despite rapid advances in endoscopic treatments and the development of updated and evidence based guidelines, morbidity and mortality in upper gastrointestinal bleeding (UGIB) remains high. A recent study conducted in a tertiary centre on 80 consecutive patients with UGIB demonstrated that lower doses of Adrenaline 1:10000 and diathermy were superior to high doses of Adrenaline injections only, but failed to reduce the mortality rates, despite a reduction in the need for transfusion, second look and surgical interventions. We believe that comorbid conditions have greater influence on survival rates in patients with UGIB than the achievement of immediate haemostasis and we attribute a paramount importance to rapid and correct resuscitation of the bleeding patient prior to any endoscopic assessment.

Towards personalised management for non-variceal upper gastrointestinal bleeding

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323846
Author(s):  
Joseph J Y Sung ◽  
Loren Laine ◽  
Ernst J Kuipers ◽  
Alan N Barkun
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Point Of Care ◽  
Management Strategies ◽  
Patient Characteristics ◽  
Professional Societies ◽  
Assessment And Treatment ◽  
Three Stages ◽  
Endoscopic Assessment ◽  
Upper Gastrointestinal

Guidelines from national and international professional societies on upper gastrointestinal bleeding highlight the important clinical issues but do not always identify specific management strategies pertaining to individual patients. Optimal treatment should consider the personal needs of an individual patient and the pertinent resources and experience available at the point of care. This article integrates international guidelines and consensus into three stages of management: pre-endoscopic assessment and treatment, endoscopic evaluation and haemostasis and postendoscopic management. We emphasise the need for personalised management strategies based on patient characteristics, nature of bleeding lesions and the clinical setting including available resources.

scholarly journals Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Miral Subhani ◽  
Kaleem Rizvon ◽  
Paul Mustacchia
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Drug Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Comorbid Conditions ◽  
Endoscopic Evaluation ◽  
Number Of Patients ◽  
Upper Gastrointestinal

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

Acute upper gastrointestinal bleeding: endoscopic assessment and treatment

2020 ◽  
Vol 18 (Sup1) ◽  
pp. S26-S35
Author(s):  
Rajan Patel ◽  
Steven Mann
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Endoscopy ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Assessment And Treatment ◽  
Medical Emergencies ◽  
The Uk ◽  
Endoscopic Assessment ◽  
Upper Gastrointestinal ◽  
Significant Mortality

Acute upper gastrointestinal bleeding (AUGIB) represents 10% of medical emergencies in the UK and is associated with a significant mortality risk. Mortality has remained steady over the past 2 decades, at approximately 10%, with over 4000 deaths per annum in the UK. Patients with significant bleeding present with symptoms of haematemesis, melaena or haematochezia (rapid transit of red blood through the GI tract). An assessment of haemodynamic stability along with adequate resuscitation is vital prior to performing safe endoscopy. The performance of prompt upper gastrointestinal endoscopy is then necessary, as it has diagnostic, prognostic and therapeutic roles. Early identification of aetiology (variceal versus non-variceal bleeding) is important and directs endoscopic and medical treatment. An increasing number of endoscopic therapeutic options are now available.

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 Duration of the acute hepatic encephalopathy episode determines survival in cirrhotic patients

2017 ◽  
Vol 11 ◽  
pp. 1756283X1774341 ◽  
Author(s):  
Meritxell Ventura-Cots ◽  
Isabel Carmona ◽  
Carolina Moreno ◽  
Javier Ampuero ◽  
Macarena Simón-Talero ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Upper Gastrointestinal Bleeding ◽  
Survival Rates ◽  
Free Survival ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
Acute Hepatic Encephalopathy ◽  
End Stage ◽  
Upper Gastrointestinal ◽  
Time Point

Background: Episodes of hepatic encephalopathy (HE) have been related to low survival rate. However, the relation between its clinical evolution and mortality has not been assessed. Methods: A retrospective analysis of 245 cirrhotic patients admitted for an acute episode of HE (⩾grade 2) or who developed an HE episode after an upper gastrointestinal bleeding (UGIB) event was performed to assess the relation between time in HE and transplant-free survival. Results: Median (IQR25–75) time in HE was 48 h (24–96 h) in the whole cohort. Patients who presented a longer time in HE (>48 h; n = 89) exhibited a lower transplant-free survival at 28 days (67.2% versus 88.9%, p < 0.001), 90 days (48.7% versus 73.8%, p < 0.001) and 365 days (30.3% versus 53.2%, p < 0.001), as compared to those with less time in HE (⩽48 h; n = 156). Survival rates remained significantly different, with lower percentages in the group with time in HE >48 h, when comparing patients according to baseline HE grade (2 versus ⩾3) or model for end-stage liver disease (MELD) function (⩽15 versus >15). Time in HE was also an independent risk factor for mortality at each time point, hazard ratio (HR) (95 CI%) 28 days 2.59 (1.39–4.84); 90 days 1.98 (1.28–3.1) and 365 days 1.5 (1.08–2.19). Conclusions: The duration of the acute HE episode determines survival in cirrhotic patients independently of liver function and baseline HE grade.

scholarly journals Do We EradicateHelicobacter pyloriin Hospitalized Patients with Peptic Ulcer Disease?

2013 ◽  
Vol 27 (11) ◽  
pp. 636-638 ◽  
Author(s):  
Frank Wong ◽  
George Ou ◽  
Sigrid Svarta ◽  
Ricky Kwok ◽  
Kieran Donaldson ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Breath Test ◽  
Upper Gastrointestinal Bleeding ◽  
Urea Breath Test ◽  
Gastric Ulcers ◽  
Treatment Rate ◽  
Ulcer Disease ◽  
Tertiary Centre ◽  
H Pylori ◽  
Upper Gastrointestinal

BACKGROUND:Helicobacter pyloriinfection is the most common chronic infection in humans. It is a major contributor to the cause of duodenal and gastric ulcers worldwide. Its eradication has been shown to reduce rates ofH pylori-related ulcers as well as other complications such as gastric cancer.OBJECTIVE: To determine the rate of appropriate treatment in patients following a diagnosis ofH pyloriinfection on biopsy during esophagoduodenoscopy for upper gastrointestinal bleeding over a four-year period at a tertiary centre in Vancouver, British Columbia. Also evaluated was the rate of eradication confirmation using the urea breath test.METHODS: A retrospective review of 1501 inpatients who underwent esophagoduodenoscopy for upper gastrointestinal bleeding (January 2006 to December 2010) was undertaken. Patients who were biopsy stain positive forH pyloriwere selected for drug review either via a provincial database (PharmaNet) or via records from patients’ family practitioners. Data were also obtained via two provincial laboratories that perform the urea breath test to determine the rates of confirmation of eradication.RESULTS: Ninety-eight patients had biopsy-provenH pylori. The mean (± SD) age was 56.13±17.9 years and 65 were male. Data were not available for 22 patients; the treatment rate was 52.6% (40 of 76). Of those treated, 12 patients underwent a post-treatment urea breath test for eradication confirmation.CONCLUSION: There was substantial discrepancy between the number of diagnosedH pyloriinfections and the rate of treatment as well as confirmation of eradication. Numerous approaches could be taken to improve treatment and eradication confirmation.

scholarly journals The Current Portrayal of Non-Variceal Upper Gastrointestinal Bleeding in a Portuguese Tertiary Center

2021 ◽  
pp. 1-6
Author(s):  
Daniela Falcão ◽  
Joana Alves da Silva ◽  
Tiago Pereira Guedes ◽  
Mónica Garrido ◽  
Inês Novo ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Outcome Data ◽  
Surgical Interventions ◽  
Ulcer Disease ◽  
Tertiary Center ◽  
Rockall Score ◽  
Therapeutic Tools ◽  
Upper Gastrointestinal

<b><i>Introduction:</i></b> Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important healthcare problem whose epidemiology and outcomes have been changing throughout the years. The main goal of this study was to characterize the current demographics, etiologies, and risk factors of NVUGIB. <b><i>Methods:</i></b> Analysis of clinical, endoscopic, and outcome data from patients who were admitted for NVUGIB between January 2016 and January 2019 in an emergency department of a tertiary hospital center. <b><i>Results:</i></b> A total of 522 patients were included, with a median age of 71 years, mainly men, with multiple comorbidities. Most patients were directly admitted, while the others were transferred from other hospitals. Peptic ulcer disease was the most common cause of NVUGIB and it was followed by tumor bleeding. Esophagogastroduodenoscopy was performed within &#x3c;12 h after hospital admission in 51.9%. In-hospital rebleeding occurred in 6.9% and overall mortality was 4.2%. Transferred patients had superior Glasgow-Blatchford score (GBS), required more blood transfusion, endoscopic and surgical interventions, and presented higher rebleeding rate, with similar mortality. Complete Rockall score (CRS) and GBS were predictors of endoscopic therapy. Surgery need was only related to CRS. Patients who rebled had superior pre-endoscopic Rockall score (RS), CRS, and GBS. Mortality was increased in patients with higher RS and CRS. <b><i>Discussion/Conclusion:</i></b> Ageing and increasing comorbidities have not been related to worse outcomes in NVUGIB. These findings seem to be the consequence of the correct use of both diagnostic and therapeutic tools in an organized and widely accessible healthcare system.

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