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1. Introduction
2. Early endoscopy (1)
3. Early endoscopy (2)
4. Endoscopic therapy
5. Adding a second therapy to epinephrine injection
6. Mono or combined therapy?
7. Mono or combined therapy? Risk of rebleeding
8. Mono or combined therapy? Mortality
9. Adding a sclerosant to epinephrine does not help
10. Clips or Thermal?
11. Clips or Thermal? Initial hemostasis
12. Clips or Thermal? Rebleeding
13. Choosing Clips or Thermal
14. Clots: remove or leave it?
15. EndoTx with iv PPI vs. iv PPI alone
16. Clots: remove or leave it? Beneficial patients
17. Clots: remove or leave it? Meta analysis (1)
18. Clots: remove or leave it? Meta analysis (2)
19. PPI before endoscopy?
20. Pre emptive PPI (1)
21. Pre emptive PPI (2)
22. Adjuvant IV PPI?
23. IV PPI cochrane review
24. PUB Study: IV nexium vs. placebo
25. Stigmata of haemorrhage
26. Significantly less rebleeding
27. Rebleeding within 30 days (ITT population)
28. Mortality and surgery within 30 days
29. Benefit irrespective of endoscopic Rx
30. Benefit more Hp positive patients
31. Second look endoscopy reduces rebleeding?
32. Second look and selective retreatment
33. Second look endoscopy
34. Endoscopic retreatment vs. surgery (1)
35. Endoscopic retreatment vs. surgery (2)
36. Outcomes: endoscopic re-treatment and surgery
37. What causes mortality?
38. Proportion of non bleeding related deaths
39. Non-bleeding related mortality (in-hospital death)
40. Bleeding related mortality (in-hospital death)
41. Should we stop aspirin?
42. More recurrent bleeding with aspirin
43. Yet, higher all-cause mortality without aspirin
44. What have we learned? (1)
45. What have we learned? (2)

Topics Covered

• Upper gastrointestinal bleeding is an important medical emergency
• The literature has provided many evidence-based management strategies
• Early endoscopy within 24 hours should be provided
• Injection for active ulcer bleeding should not be used as a monotherapy
• Thermal device (heat probe) is comparable to mechanical device (hemoclips)
• Underlying vessel beneath blood clot should exposed and treated
• Pre-endoscopy use of proton pump inhibitor may reduce need for endoscopic therapy
• Intravenous proton pump inhibitor is an important adjuvant to endoscopic therapy
• Routine second-look endoscopy is not recommended
• Surgery is still providing the ultimate hemostasis in selected cases
• Support of cardiopulmonary conditions is important to reduce mortality
• Anti-platelet agent should be restarted as soon as patient's condition stabilizes

Links

Series:

• Gastroenterology and Hepatology

Categories:

• Clinical Practice

Therapeutic Areas:

• Gastroenterology & Nephrology

Talk Citation

Sung, J.J. (2011, January 5). Evidence-based management of non-variceal upper GI bleeding [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 21, 2024, from https://doi.org/10.69645/HZVO4654.
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Publication History

• Published on January 5, 2011

Financial Disclosures

• Prof. Joseph J. Sung has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.