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[Endoscopy in non-variceal upper gastrointestinal bleeding].

Authors: Mario Arturo, Ballesteros Amozurrutia;

[Endoscopy in non-variceal upper gastrointestinal bleeding].

Abstract

Non variceal upper gastrointestinal bleeding (NVUGIB) still is a common cause of hospital admissions, morbidity and a significant mortality. A decrease trend has recently been documented thank to the general use of therapeutic endoscopy in spite of a greater use of non steroidal antinflamatory agents (NSAID) and a growing senile population. Most of NVUGIB are caused by peptic ulcer (PU) and usually stop spontaneously, but 15% of cases need endoscopic or surgical intervention. Clinically these patients can be identified by the presence of shock, orthostatic hypotension or associated organ failures (Rockall scale) and by endoscopic findings of active bleeding or non bleeding visible vessel (Forrest scale) both useful and complimentary. There are diverse endoscopic techniques to halt NVUGIB, with transendoscopic saline injection with or w/o epinephrine + coaptive bipolar electrocoagulation or heater probe being the gold standard with 85 to 90% initial success, and furthermore stopping recurrences in similar figures. Under these circumstances new methods as argon plasma electrocoagulation or mechanic methods such as endoclips or banding have difficulty to demonstrate their usefulness when compared to established procedures, but still may have some indications such as diffuse gastric or vascular lesions for argon plasma electrocoagulation, and bands or endoclips for deep ulcers given their lower risk of perforation. Antisecretory agents are useful complementary treatment decreasing recurrence by 8% when used at high doses. Hp eradication decreases PU and NVUGIB recurrence, except in patients who ingest NSAID on a regular basis who require nocturnal antisecretory treatment.

Keywords

Aged, 80 and over, Mallory-Weiss Syndrome, Epinephrine, Anti-Inflammatory Agents, Non-Steroidal, Hemostasis, Endoscopic, Age Factors, Proton Pump Inhibitors, Middle Aged, Anti-Ulcer Agents, Peptic Ulcer Hemorrhage, Risk Factors, Duodenal Ulcer, Electrocoagulation, Secondary Prevention, Humans, Prospective Studies, Gastrointestinal Hemorrhage, Aged, Randomized Controlled Trials as Topic, Retrospective Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
gold