An update on the management of non-variceal upper gastrointestinal bleeding

Ali A Alali 1, Alan N Barkun 2

Affiliations

doi: 0.1093/gastro/goad011

Abstract

Upper gastrointestinal bleeding (UGIB) continues to be a common gastrointestinal emergency that carries significant morbidity and mortality. The epidemiology of UGIB has been changing over the last few decades with an overall decrease in peptic ulcer disease and increase in the prevalence of other etiologies including vascular lesions and malignancy. Appropriate risk assessment and patient stratification are crucial to ensuring that optimal care is delivered to patients and some risk assessment tools have shown excellent ability to define a low-risk group who can be managed as outpatients safely. Regardless of the etiology of UGIB, resuscitative interventions by primary care providers remain the most important initial measures to improve the outcome for patients including hemodynamic stabilization, an appropriate blood transfusion strategy, with or without acid-lowering agents, while also providing subsequent urgent endoscopic assessment and intervention. In addition, with increasing use of antithrombotic agents in clinical practice and its associated risk of bleeding, the management of such agents in the acute setting has become a real challenge to all physicians. In this article, we provide an up-to-date, evidence-based, practical review of recent changes and advances in UGIB with a focus on non-variceal etiologies.

Keywords: UGIB; antithrombotic; endoscopic hemostasis; peptic ulcer; risk assessment.

Conflict of interest statement

None declared.

Figures

Figure 1. The Yano–Yamamoto classification of vascular lesions (modified from the study by Yano et al. [27])

Figure 1. The Yano–Yamamoto classification of vascular lesions (modified from the study by Yano et al. [27])

Figure 2. Actively bleeding Dieulafoy’s lesion in the small bowel

Figure 2. Actively bleeding Dieulafoy’s lesion in the small bowel

Figure 3. Images of hemostasis with the use of through-the-scope clips (TTS). (A) Adherent clot on a duodenal ulcer; (B) the edge of the ulcer is injected with dilute epinephrine; (C) the clot is removed using a snare; (D) definite hemostasis is achieved using through-the-scope endoscopic clips. show full caption.

Figure 3. Images of hemostasis with the use of through-the-scope clips (TTS). (A) Adherent clot on a duodenal ulcer; (B) the edge of the ulcer is injected with dilute epinephrine; (C) the clot is removed using a snare; (D) definite hemostasis is achieved using through-the-scope endoscopic clips. show full caption.

Similar articles

Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

Khamaysi I, Gralnek IM.Best Pract Res Clin Gastroenterol. 2013 Oct;27(5):633-8. doi: 10.1016/j.bpg.2013.09.002. Epub 2013 Sep 25.PMID: 24160923 Review.

[Clinical epidemiological characteristics and change trend of upper gastrointestinal bleeding over the past 15 years].

Wang J, Cui Y, Wang J, Chen B, He Y, Chen M.Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Apr 25;20(4):425-431.PMID: 28440524 Chinese.

Etiology and adverse outcome predictors of upper gastrointestinal bleeding in 589 patients in Nepal.

Shrestha UK, Sapkota S.Dig Dis Sci. 2014 Apr;59(4):814-22. doi: 10.1007/s10620-013-2946-9. Epub 2013 Nov 27.PMID: 24282053

Adherence to guidelines in patients with non-variceal upper gastrointestinal bleeding (UGIB) - results from a retrospective single tertiary center registry.

Prosenz J, Stättermayer MS, Riedl F, Maieron A.Scand J Gastroenterol. 2023 Feb 28:1-7. doi: 10.1080/00365521.2023.2183734. Online ahead of print.PMID: 36855301

AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review.

Mullady DK, Wang AY, Waschke KA.Gastroenterology. 2020 Sep;159(3):1120-1128. doi: 10.1053/j.gastro.2020.05.095. Epub 2020 Jun 20.PMID: 32574620 Review.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Abougergi MS, Travis AC, Saltzman JR.. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc 2015;81:882–8.e1. - PubMed
  2.  
    1. Patel SD, Desai R, Patel U. et al. Thirty-day readmissions after upper and lower gastrointestinal hemorrhage: a national perspective in the United States. J Clin Gastroenterol 2019;53:582–90. - PubMed
  3.  
    1. Wuerth BA, Rockey DC.. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: a nationwide analysis. Dig Dis Sci 2018;63:1286–93. - PubMed
  4.  
    1. Gupta A, Agarwal R, Ananthakrishnan AN.. “Weekend effect” in patients with upper gastrointestinal hemorrhage: a systematic review and meta-analysis. Am J Gastroenterol 2018;113:13–21. - PubMed
  5.  
    1. van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008;22:209–24. - PubMed
  6.  
    1. Rockall TA, Logan RF, Devlin HB. et al. Variation in outcome after acute upper gastrointestinal haemorrhage: the National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet 1995;346:346–50. - PubMed
  7.  
    1. Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995;90:206–10. - PubMed
  8.  
    1. Boonpongmanee S, Fleischer DE, Pezzullo JC. et al. The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 2004;59:788–94. - PubMed
  9.  
    1. Enestvedt BK, Gralnek IM, Mattek N. et al. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc 2008;67:422–9. - PubMed
  10.  
    1. Loperfido S, Baldo V, Piovesana E. et al. Changing trends in acute upper-GI bleeding: a population-based study. Gastrointest Endosc 2009;70:212–24. - PubMed
  11.  
    1. Sonnenberg A, Turner KO, Genta RM.. Low prevalence of helicobacter pylori-positive peptic ulcers in private outpatient endoscopy centers in the United States. Am J Gastroenterol 2020;115:244–50. - PubMed
  12.  
    1. Yuan C, Adeloye D, Luk TT. et al. The global prevalence of and factors associated with Helicobacter pylori infection in children: a systematic review and meta-analysis. Lancet Child Adolescent Health 2022;6:185–94. - PubMed
  13.  
    1. Lu Y, Barkun AN, Martel M.. Adherence to guidelines: a national audit of the management of acute upper gastrointestinal bleeding—the REASON registry. Can J Gastroenterol Hepatol 2014;28:495–501. - PMC - PubMed
  14.  
    1. Forrest JA, Finlayson ND, Shearman DJ.. Endoscopy in gastrointestinal bleeding. Lancet 1974;2:394–7. - PubMed
  15.  
    1. Balderas V, Bhore R, Lara LF. et al. The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes. Am J Med 2011;124:970–6. - PubMed
  16.  
    1. Costa ND, Cadiot G, Merle C. et al. Bleeding reflux esophagitis: a prospective 1-year study in a university hospital. Am J Gastroenterol 2001;96:47–51. - PubMed
  17.  
    1. Rath HC, Timmer A, Kunkel C. et al. Comparison of interobserver agreement for different scoring systems for reflux esophagitis: impact of level of experience. Gastrointest Endosc 2004;60:44–9. - PubMed
  18.  
    1. Guntipalli P, Chason R, Elliott A. et al. Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome. Dig Dis Sci 2014;59:2997–3003. - PubMed
  19.  
    1. Michel L, Serrano A, Malt RA.. Mallory-Weiss syndrome: evolution of diagnostic and therapeutic patterns over two decades. Ann Surg 1980;192:716–21. - PMC - PubMed
  20.  
    1. Park CH, Min SW, Sohn YH. et al. A prospective, randomized trial of endoscopic band ligation vs. epinephrine injection for actively bleeding Mallory-Weiss syndrome. Gastrointest Endosc 2004;60:22–7. - PubMed
  21.  
    1. Llach J, Elizalde JI, Guevara MC. et al. Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial. Gastrointest Endosc 2001;54:679–81. - PubMed
  22.  
    1. Laine L, Barkun AN, Saltzman JR. et al. ACG Clinical Guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol 2021;116:899–917. - PubMed
  23.  
    1. Lecleire S, Antonietti M, Iwanicki-Caron I. et al. Endoscopic band ligation could decrease recurrent bleeding in Mallory-Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine. Aliment Pharmacol Ther 2009;30:399–405. - PubMed
  24.  
    1. Cho YS, Chae HS, Kim HK. et al. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding. World J Gastroenterol 2008;14:2080–4. - PMC - PubMed
  25.  
    1. Baracat FI, de Moura DTH, Brunaldi VO. et al. Randomized controlled trial of hemostatic powder versus endoscopic clipping for non-variceal upper gastrointestinal bleeding. Surg Endosc 2020;34:317–24. - PubMed
  26.  
    1. Chahal D, Lee JGH, Ali-Mohamad N. et al. High rate of re-bleeding after application of Hemospray for upper and lower gastrointestinal bleeds. Dig Liver Dis 2020;52:768–72. - PubMed
  27.  
    1. Yano T, Yamamoto H, Sunada K. et al. Endoscopic classification of vascular lesions of the small intestine (with videos). Gastrointest Endosc 2008;67:169–72. - PubMed
  28.  
    1. Clouse RE, Costigan DJ, Mills BA. et al. Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Intern Med 1985;145:458–61. - PubMed
  29.  
    1. Marwick T, Kerlin P.. Angiodysplasia of the upper gastrointestinal tract: clinical spectrum in 41 cases. J Clin Gastroenterol 1986;8:404–7. - PubMed
  30.  
    1. Gunnlaugsson O. Angiodysplasia of the stomach and duodenum. Gastrointest Endosc 1985;31:251–4. - PubMed
  31.  
    1. Chalasani N, Cotsonis G, Wilcox CM.. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol 1996;91:2329–32. - PubMed
  32.  
    1. Alhumood SA, Devine DV, Lawson L. et al. Idiopathic immune-mediated acquired von Willebrand's disease in a patient with angiodysplasia: demonstration of an unusual inhibitor causing a functional defect and rapid clearance of von Willebrand factor. Am J Hematol 1999;60:151–7. - PubMed
  33.  
    1. Pate GE, Mulligan A.. An epidemiological study of Heyde's syndrome: an association between aortic stenosis and gastrointestinal bleeding. J Heart Valve Dis 2004;13:713–6. - PubMed
  34.  
    1. Singh G, Albeldawi M, Kalra SS. et al. Features of patients with gastrointestinal bleeding after implantation of ventricular assist devices. Clin Gastroenterol Hepatol 2015;13:107–14.e1. - PubMed
  35.  
    1. Demirozu ZT, Radovancevic R, Hochman LF. et al. Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant 2011;30:849–53. - PubMed
  36.  
    1. Dailey J, Nguyen LH, Kohli A. et al. A multicenter study of left ventricular assist device-related gastrointestinal bleeding. Clin Transl Gastroenterol 2022;13:e00526. - PMC - PubMed
  37.  
    1. Lara LF, Silva R, Thakkar S. et al. Multicenter case series of patients with small-bowel angiodysplasias treated with a small-bowel radiofrequency ablation catheter. VideoGIE 2020;5:162–7. - PMC - PubMed
  38.  
    1. Selinger CP, Ang YS.. Gastric antral vascular ectasia (GAVE): an update on clinical presentation, pathophysiology and treatment. Digestion 2008;77:131–7. - PubMed
  39.  
    1. Dulai GS, Jensen DM, Kovacs TO. et al. Endoscopic treatment outcomes in watermelon stomach patients with and without portal hypertension. Endoscopy 2004;36:68–72. - PubMed
  40.  
    1. Hirsch BS, Ribeiro IB, Funari MP. et al. Endoscopic band ligation versus argon plasma coagulation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis of randomized controlled trials. Clin Endosc 2021;54:669–77. - PMC - PubMed
  41.  
    1. McCarty TR, Rustagi T.. Comparative effectiveness and safety of radiofrequency ablation versus argon plasma coagulation for treatment of gastric antral vascular ectasia: a systematic review and meta-analysis. J Clin Gastroenterol 2019;53:599–606. - PubMed
  42.  
    1. Park CH, Joo YE, Kim HS. et al. A prospective, randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy's lesions. Endoscopy 2004;36:677–81. - PubMed
  43.  
    1. Ahn DW, Lee SH, Park YS. et al. Hemostatic efficacy and clinical outcome of endoscopic treatment of Dieulafoy's lesions: comparison of endoscopic hemoclip placement and endoscopic band ligation. Gastrointest Endosc 2012;75:32–8. - PubMed
  44.  
    1. Savides TJ, Jensen DM, Cohen J. et al. Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy 1996;28:244–8. - PubMed
  45.  
    1. Alali A, Moosavi S, Martel M. et al. Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis. Endosc Int Open 2022. 10.1055/a-1984-6895. - DOI
  46.  
    1. Oakland K. Risk stratification in upper and upper and lower GI bleeding: which scores should we use? Best Pract Res Clin Gastroenterol 2019;42–43:101613. - PubMed
  47.  
    1. Gralnek IM, Stanley AJ, Morris AJ. et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline—Update 2021. Endoscopy 2021;53:300–32. - PubMed
  48.  
    1. Rockall TA, Logan RF, Devlin HB. et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996;38:316–21. - PMC - PubMed
  49.  
    1. Cheng HC, Wu CT, Chang WL. et al. Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study. Gut 2014;63:1864–72. - PubMed
  50.  
    1. Bryant RV, Kuo P, Williamson K. et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013;78:576–83. - PubMed
  51.  
    1. Taha AS, McCloskey C, Craigen T. et al. Antithrombotic drugs and non-variceal bleeding outcomes and risk scoring systems: comparison of Glasgow Blatchford, Rockall and Charlson scores. Frontline Gastroenterol 2016;7:257–63. - PMC - PubMed
  52.  
    1. Blatchford O, Murray WR, Blatchford M.. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet 2000;356:1318–21. - PubMed
  53.  
    1. Stanley AJ, Laine L, Dalton HR. et al. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. BMJ 2017;356:i6432. - PMC - PubMed
  54.  
    1. Gu L, Xu F, Yuan J.. Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC Gastroenterol 2018;18:98. - PMC - PubMed
  55.  
    1. Oakland K, Kahan BC, Guizzetti L. et al. Development, validation, and comparative assessment of an international scoring system to determine risk of upper gastrointestinal bleeding. Clin Gastroenterol Hepatol 2019;17:1121–9.e2. - PubMed
  56.  
    1. Saltzman JR, Tabak YP, Hyett BH. et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest Endosc 2011;74:1215–24. - PubMed
  57.  
    1. Abougergi MS, Charpentier JP, Bethea E. et al. A prospective, multicenter study of the AIMS65 score compared with the Glasgow-Blatchford score in predicting upper gastrointestinal hemorrhage outcomes. J Clin Gastroenterol 2016;50:464–9. - PubMed
  58.  
    1. Kim MS, Choi J, Shin WC.. AIMS65 scoring system is comparable to Glasgow-Blatchford score or Rockall score for prediction of clinical outcomes for non-variceal upper gastrointestinal bleeding. BMC Gastroenterol 2019;19:136. - PMC - PubMed
  59.  
    1. Lau JY. The value of risk scores to predict clinical outcomes in patients with variceal and non-variceal upper gastrointestinal bleeding. Clin Endosc 2021;54:145–6. - PMC - PubMed
  60.  
    1. Laursen SB, Oakland K, Laine L. et al. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut 2021;70:707–16. - PubMed
  61.  
    1. Kherad O, Restellini S, Almadi M. et al. Comparative evaluation of the ABC score to other risk stratification scales in managing high-risk patients presenting with acute upper gastrointestinal bleeding. J Clin Gastroenterol 2022. https://doi.org/10.1097/MCG.0000000000001720. - DOI
  62.  
    1. Mules TC, Stedman C, Ding S. et al. Comparison of risk scoring systems in hospitalised patients who develop upper gastrointestinal bleeding. GastroHep 2021;3:5–11.
  63.  
    1. Ramaekers R, Mukarram M, Smith CA. et al. The predictive value of preendoscopic risk scores to predict adverse outcomes in emergency department patients with upper gastrointestinal bleeding: a systematic review. Acad Emerg Med 2016;23:1218–27. - PubMed
  64.  
    1. Robertson M, Majumdar A, Boyapati R. et al. Risk stratification in acute upper GI bleeding: comparison of the AIMS65 score with the Glasgow-Blatchford and Rockall scoring systems. Gastrointest Endosc 2016;83:1151–60. - PubMed
  65.  
    1. Martínez-Cara JG, Jiménez-Rosales R, Úbeda-Muñoz M. et al. Comparison of AIMS65, Glasgow-Blatchford score, and Rockall score in a European series of patients with upper gastrointestinal bleeding: performance when predicting in-hospital and delayed mortality. United European Gastroenterol J 2016;4:371–9. - PMC - PubMed
  66.  
    1. Park SM, Yeum SC, Kim BW. et al. Comparison of AIMS65 score and other scoring systems for predicting clinical outcomes in Koreans with nonvariceal upper gastrointestinal bleeding. Gut Liver 2016;10:526–31. - PMC - PubMed
  67.  
    1. Thanapirom K, Ridtitid W, Rerknimitr R. et al. Prospective comparison of three risk scoring systems in non-variceal and variceal upper gastrointestinal bleeding. J Gastroenterol Hepatol 2016;31:761–7. - PubMed
  68.  
    1. Laursen SB, Hansen JM, Schaffalitzky de Muckadell OB.. The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol 2012;10:1130–5.e1. - PubMed
  69.  
    1. Barkun AN, Almadi M, Kuipers EJ. et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med 2019;171:805–22. - PMC - PubMed
  70.  
    1. Odutayo A, Desborough MJ, Trivella M. et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol 2017;2:354–60. - PubMed
  71.  
    1. Docherty AB, O'Donnell R, Brunskill S. et al. Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis. BMJ 2016;352:i1351. - PMC - PubMed
  72.  
    1. Rahman R, Nguyen DL, Sohail U. et al. Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review. Ann Gastroenterol 2016;29:312–7. - PMC - PubMed
  73.  
    1. Na HK, Jung HY, Seo DW. et al. Erythromycin infusion prior to endoscopy for acute nonvariceal upper gastrointestinal bleeding: a pilot randomized controlled trial. Korean J Intern Med 2017;32:1002–9. - PMC - PubMed
  74.  
    1. Barkun AN, Bardou M, Martel M. et al. Prokinetics in acute upper GI bleeding: a meta-analysis. Gastrointest Endosc 2010;72:1138–45. - PubMed
  75.  
    1. Lau JY, Leung WK, Wu JC. et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007;356:1631–40. - PubMed
  76.  
    1. Hawkey GM, Cole AT, McIntyre AS. et al. Drug treatments in upper gastrointestinal bleeding: value of endoscopic findings as surrogate end points. Gut 2001;49:372–9. - PMC - PubMed
  77.  
    1. Kanno T, Yuan Y, Tse F. et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev 2022;1:CD005415. - PMC - PubMed
  78.  
    1. Siau K, Hearnshaw S, Stanley AJ. et al. British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding. Frontline Gastroenterol 2020;11:311–23. - PMC - PubMed
  79.  
    1. Mullady DK, Wang AY, Waschke KA.. AGA clinical practice update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterology 2020;159:1120–8. - PubMed
  80.  
    1. Tsoi KK, Lau JY, Sung JJ.. Cost-effectiveness analysis of high-dose omeprazole infusion before endoscopy for patients with upper-GI bleeding. Gastrointest Endosc 2008;67:1056–63. - PubMed
  81.  
    1. Barkun AN. Should every patient with suspected upper GI bleeding receive a proton pump inhibitor while awaiting endoscopy? Gastrointest Endosc 2008;67:1064–6. - PubMed
  82.  
    1. Al-Sabah S, Barkun AN, Herba K. et al. Cost-effectiveness of proton-pump inhibition before endoscopy in upper gastrointestinal bleeding. Clin Gastroenterol Hepatol 2008;6:418–25. - PubMed
  83.  
    1. Garg SK, Anugwom C, Campbell J. et al. Early esophagogastroduodenoscopy is associated with better outcomes in upper gastrointestinal bleeding: a nationwide study. Endosc Int Open 2017;5:E376–e386. - PMC - PubMed
  84.  
    1. Siau K, Hodson J, Ingram R. et al. Time to endoscopy for acute upper gastrointestinal bleeding: results from a prospective multicentre trainee-led audit. United European Gastroenterol J 2019;7:199–209. - PMC - PubMed
  85.  
    1. Shih PC, Liu SJ, Li ST. et al. Weekend effect in upper gastrointestinal bleeding: a systematic review and meta-analysis. PeerJ 2018;6:e4248. - PMC - PubMed
  86.  
    1. Laursen SB, Leontiadis GI, Stanley AJ. et al. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc 2017;85:936–44.e3. - PubMed
  87.  
    1. Lau JYW, Yu Y, Tang RSY. et al. Timing of endoscopy for acute upper gastrointestinal bleeding. N Engl J Med 2020;382:1299–308. - PubMed
  88.  
    1. Garcia-Tsao G, Abraldes JG, Berzigotti A. et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65:310–35. - PubMed
  89.  
    1. Elmunzer BJ, Young SD, Inadomi JM. et al. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol 2008;103:2625–32; quiz 2633. - PubMed
  90.  
    1. Laine L, Peterson WL.. Bleeding peptic ulcer. N Engl J Med 1994;331:717–27. - PubMed
  91.  
    1. Jensen DM, Eklund S, Persson T. et al. Reassessment of rebleeding Risk of Forrest IB (Oozing) peptic ulcer bleeding in a large international randomized trial. Am J Gastroenterol 2017;112:441–6. - PMC - PubMed
  92.  
    1. Laine L, McQuaid KR.. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009;7:33–47. - PubMed
  93.  
    1. Chung IK, Ham JS, Kim HS. et al. Comparison of the hemostatic efficacy of the endoscopic hemoclip method with hypertonic saline-epinephrine injection and a combination of the two for the management of bleeding peptic ulcers. Gastrointest Endosc 1999;49:13–8. - PubMed
  94.  
    1. Ljubicic N, Budimir I, Biscanin A. et al. Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding. World J Gastroenterol 2012;18:2219–24. - PMC - PubMed
  95.  
    1. Schmidt A, Gölder S, Goetz M. et al. Over-the-scope clips are more effective than standard endoscopic therapy for patients with recurrent bleeding of peptic ulcers. Gastroenterology 2018;155:674–86.e6. - PubMed
  96.  
    1. Bapaye J, Chandan S, Naing LY. et al. Safety and efficacy of over-the-scope clips versus standard therapy for high-risk nonvariceal upper GI bleeding: systematic review and meta-analysis. Gastrointest Endosc 2022;96:712–20.e7. - PubMed
  97.  
    1. Barkun AN, Laine L, Leontiadis GI. et al. Over-the-scope clips versus standard treatment. Gut 2022;2022:327712. - PubMed
  98.  
    1. Takizawa K, Oda I, Gotoda T. et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors. Endoscopy 2008;40:179–83. - PubMed
  99.  
    1. Toka B, Eminler AT, Karacaer C. et al. Comparison of monopolar hemostatic forceps with soft coagulation versus hemoclip for peptic ulcer bleeding: a randomized trial (with video). Gastrointest Endosc 2019;89:792–802. - PubMed
  100.  
    1. Arima S, Sakata Y, Ogata S. et al. Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial. J Gastroenterol 2010;45:501–5. - PubMed
  101.  
    1. Kim JW, Jang JY, Lee CK. et al. Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer: a randomized trial. Endoscopy 2015;47:680–7. - PubMed
  102.  
    1. Nunoue T, Takenaka R, Hori K. et al. A randomized trial of monopolar soft-mode coagulation versus heater probe thermocoagulation for peptic ulcer bleeding. J Clin Gastroenterol 2015;49:472–6. - PubMed
  103.  
    1. Wang HM, Tsai WL, Yu HC. et al. Improvement of short-term outcomes for high-risk bleeding peptic ulcers with addition of argon plasma coagulation following endoscopic injection therapy: a randomized controlled trial. Medicine (Baltimore) 2015;94:e1343. - PMC - PubMed
  104.  
    1. Karaman A, Baskol M, Gursoy S. et al. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding. World J Gastroenterol 2011;17:4109–12. - PMC - PubMed
  105.  
    1. Taghavi SA, Soleimani SM, Hosseini-Asl SM. et al. Adrenaline injection plus argon plasma coagulation versus adrenaline injection plus hemoclips for treating high-risk bleeding peptic ulcers: a prospective, randomized trial. Can J Gastroenterol 2009;23:699–704. - PMC - PubMed
  106.  
    1. Chen YI, Barkun AN, Soulellis C. et al. Use of the endoscopically applied hemostatic powder TC-325 in cancer-related upper GI hemorrhage: preliminary experience (with video). Gastrointest Endosc 2012;75:1278–81. - PubMed
  107.  
    1. Sung JJ, Luo D, Wu JC. et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011;43:291–5. - PubMed
  108.  
    1. Rodríguez de Santiago E, Burgos-Santamaría D, Pérez-Carazo L. et al.; TC-325 Collaboration Project, Endoscopy Group of the Spanish Association of Gastroenterology. Hemostatic spray powder TC-325 for GI bleeding in a nationwide study: survival and predictors of failure via competing risks analysis. Gastrointest Endosc 2019;90:581–90.e6. - PubMed
  109.  
    1. Chen YI, Wyse J, Lu Y. et al. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc 2020;91:321–8.e1. - PubMed
  110.  
    1. Haddara S, Jacques J, Lecleire S. et al. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the "GRAPHE" registry). Endoscopy 2016;48:1084–95. - PubMed
  111.  
    1. Hussein M, Alzoubaidi D, Lopez MF. et al. Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry. Endoscopy 2021;53:36–43. - PubMed
  112.  
    1. Kwek BEA, Ang TL, Ong PLJ. et al. TC-325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high-risk bleeding stigmata: a randomized pilot study. J Dig Dis 2017;18:323–9. - PubMed
  113.  
    1. Lau JYW, Pittayanon R, Kwek A. et al. Comparison of a hemostatic powder and standard treatment in the control of active bleeding from upper nonvariceal lesions: a multicenter, noninferiority, randomized trial. Ann Intern Med 2022;175:171–8. - PubMed
  114.  
    1. de Rezende DT, Brunaldi VO, Bernardo WM. et al. Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis. Endosc Int Open 2019;7:e1704–13. - PMC - PubMed
  115.  
    1. Chen YI, Barkun AN.. Hemostatic powders in gastrointestinal bleeding: a systematic review. Gastrointest Endosc Clin N Am 2015;25:535–52. - PubMed
  116.  
    1. Chen YI, Barkun A, Nolan S.. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy 2015;47:167–71. - PubMed
  117.  
    1. Kim YJ, Park JC, Kim EH. et al. Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy. Endosc Int Open 2018;6:e700–5. - PMC - PubMed
  118.  
    1. Beg S, Al-Bakir I, Bhuva M. et al. Early clinical experience of the safety and efficacy of EndoClot in the management of non-variceal upper gastrointestinal bleeding. Endosc Int Open 2015;3:E605–9. - PMC - PubMed
  119.  
    1. Park JC, Kim YJ, Kim EH. et al. Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: Using propensity score matching. J Gastroenterol Hepatol 2018;33:1500–6. - PubMed
  120.  
    1. Prei JC, Barmeyer C, Bürgel N. et al. EndoClot polysaccharide hemostatic system in nonvariceal gastrointestinal bleeding: results of a prospective multicenter observational pilot study. J Clin Gastroenterol 2016;50:e95–100. - PubMed
  121.  
    1. de Nucci G, Reati R, Arena I. et al. Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding. Endoscopy 2020;52:773–9. - PubMed
  122.  
    1. Song H, Zhang L, Zhao X.. Hemostatic efficacy of biological self-assembling peptide nanofibers in a rat kidney model. Macromol Biosci 2010;10:33–9. - PubMed
  123.  
    1. Luo Z, Wang S, Zhang S.. Fabrication of self-assembling D-form peptide nanofiber scaffold d-EAK16 for rapid hemostasis. Biomaterials 2011;32:2013–20. - PubMed
  124.  
    1. Branchi F, Klingenberg-Noftz R, Friedrich K. et al. PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study. Surg Endosc 2022;36:2954–61. - PMC - PubMed
  125.  
    1. Subramaniam S, Kandiah K, Thayalasekaran S. et al. Haemostasis and prevention of bleeding related to ER: the role of a novel self-assembling peptide. United European Gastroenterol J 2019;7:155–62. - PMC - PubMed
  126.  
    1. Jensen DM, Ohning GV, Kovacs TO. et al. Doppler endoscopic probe as a guide to risk stratification and definitive hemostasis of peptic ulcer bleeding. Gastrointest Endosc 2016;83:129–36. - PMC - PubMed
  127.  
    1. Chapelle N, Martel M, Bardou M. et al. Role of the endoscopic Doppler probe in nonvariceal upper gastrointestinal bleeding: systematic review and meta-analysis. Dig Endosc 2023;35(1):4–18. 10.1111/den.14356. - DOI - PubMed
  128.  
    1. Barkun AN, Adam V, Wong RCK.. Use of Doppler probe in nonvariceal upper-gastrointestinal bleeding is less costly and more effective than standard of care. Clin Gastroenterol Hepatol 2019;17:2463–70. - PubMed
  129.  
    1. Leontiadis GI, Sharma VK, Howden CW.. Proton pump inhibitor treatment for acute peptic ulcer bleeding. Cochrane Database Syst Rev 2006;1:CD002094. - PubMed
  130.  
    1. Sachar H, Vaidya K, Laine L.. Intermittent vs continuous proton pump inhibitor therapy for high-risk bleeding ulcers: a systematic review and meta-analysis. JAMA Intern Med 2014;174:1755–62. - PMC - PubMed
  131.  
    1. Tsoi KK, Hirai HW, Sung JJ.. Meta-analysis: comparison of oral vs. intravenous proton pump inhibitors in patients with peptic ulcer bleeding. Aliment Pharmacol Ther 2013;38:721–8. - PubMed
  132.  
    1. Sung JJ, Suen BY, Wu JC. et al. Effects of intravenous and oral esomeprazole in the prevention of recurrent bleeding from peptic ulcers after endoscopic therapy. Am J Gastroenterol 2014;109:1005–10. - PubMed
  133.  
    1. Barkun AN, Herba K, Adam V. et al. The cost-effectiveness of high-dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding. Aliment Pharmacol Ther 2004;20:195–202. - PubMed
  134.  
    1. Hearnshaw SA, Logan RF, Lowe D. et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011;60:1327–35. - PubMed
  135.  
    1. Lau JY, Barkun A, Fan DM. et al. Challenges in the management of acute peptic ulcer bleeding. Lancet 2013;381:2033–43. - PubMed
  136.  
    1. Shung DL, Au B, Taylor RA. et al. Validation of a machine learning model that outperforms clinical risk scoring systems for upper gastrointestinal bleeding. Gastroenterology 2020;158:160–7. - PMC - PubMed
  137.  
    1. García-Iglesias P, Villoria A, Suarez D. et al. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther 2011;34:888–900. - PubMed
  138.  
    1. Birda CL, Kumar A, Samanta J.. Endotherapy for nonvariceal upper gastrointestinal hemorrhage. Journal of Digestive Endoscopy 2021;12:78–92.
  139.  
    1. Lau JY, Sung JJ, Lam YH. 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. - PubMed
  140.  
    1. Tarasconi A, Baiocchi GL, Pattonieri V. et al. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World J Emerg Surg 2019;14:3. - PMC - PubMed
  141.  
    1. Sverdén E, Mattsson F, Lindström D. et al. Transcatheter arterial embolization compared with surgery for uncontrolled peptic ulcer bleeding: a population-based cohort study. Ann Surg 2019;269:304–9. - PubMed
  142.  
    1. Lau JYW, Pittayanon R, Wong KT. et al. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial. Gut 2019;68:796–803. - PubMed
  143.  
    1. Hopkins RJ, Girardi LS, Turney EA.. Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review. Gastroenterology 1996;110:1244–52. - PubMed
  144.  
    1. Ford AC, Gurusamy KS, Delaney B. et al. Eradication therapy for peptic ulcer disease in Helicobacter pylori‐positive people. Cochrane Database Syst Rev 2016;4:CD003840. - PMC - PubMed
  145.  
    1. Gisbert JP, Khorrami S, Carballo F. et al. 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. - PubMed
  146.  
    1. Barkun AN, Bardou M, Kuipers EJ. et al.; International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010;152:101–13. - PubMed
  147.  
    1. Chang SS, Hu HY.. Helicobacter pylori eradication within 120 days is associated with decreased complicated recurrent peptic ulcers in peptic ulcer bleeding patients. Gut Liver 2015;9:346–52. - PMC - PubMed
  148.  
    1. Sverdén E, Brusselaers N, Wahlin K. et al. Time latencies of Helicobacter pylori eradication after peptic ulcer and risk of recurrent ulcer, ulcer adverse events, and gastric cancer: a population-based cohort study. Gastrointest Endosc 2018;88:242–50.e1. - PubMed
  149.  
    1. Abraham NS, Barkun AN, Sauer BG. et al. American College of Gastroenterology–Canadian Association of Gastroenterology clinical practice guideline: management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;117:542–58. - PMC - PubMed
  150.  
    1. Barkun AN, Douketis J, Noseworthy PA. et al. Management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period: a clinical practice guideline dissemination tool. Am J Gastroenterol 2022;117:513–9. - PubMed
  151.  
    1. Cheung J, Rajala J, Moroz D. et al. Acetylsalicylic acid use in patients with acute myocardial infarction and peptic ulcer bleeding. Can J Gastroenterol 2009;23:619–23. - PMC - PubMed
  152.  
    1. Sung JJ, Lau JY, Ching JY. et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010;152:1–9. - PubMed
  153.  
    1. Chan FKL, Goh KL, Reddy N. et al. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines. Gut 2018;67:405–17. - PMC - PubMed

Page Navigation