Upper gastrointestinal bleeding

Noel B. Martins, Wahid Wassef

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations

Abstract

PURPOSE OF REVIEW: This review provides an update on the management of upper gastrointestinal bleeding with special attention to patient preparation, sedation, hemostatic techniques, and postprocedure care. RECENT FINDINGS: In a large multicenter clinical trial, nurse-administered propofol sedation had a complication rate of less than 0.2%. The optimal management for an ulcer with adherent clot was confirmed by a meta-analysis to be clot removal and endoscopic treatment of the underlying lesion. A number of prospective studies have demonstrated that capsule endoscopy is the most sensitive imaging modality for identifying lesions in the small bowel and that double-balloon enteroscopy is the least invasive modality available for the management of these lesions. SUMMARY: This update describes many recent advances in the diagnosis and management of upper gastrointestinal bleeding. However, clearly, much work needs to be done in this field. Since propofol is not available for use in all endoscopy units, is there a better alternative for deep sedation? Rebleeding occurs in 20% of patients after endoscopic therapy, and so can we provide better outcomes with newer technologies (endoscopic suturing devices)? Finally, what is the best management for Helicobacter pylori-negative, nonsteroidal antiinflammatory drug-negative ulcer patients?

Original languageEnglish (US)
Pages (from-to)612-619
Number of pages8
JournalCurrent Opinion in Gastroenterology
Volume22
Issue number6
DOIs
StatePublished - Nov 2006
Externally publishedYes

Keywords

  • Capsule endoscopy
  • Double-balloon enteroscopy
  • Hemoclipping
  • Propofol
  • Upper gastrointestinal bleeding

ASJC Scopus subject areas

  • Gastroenterology

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