DOCSLIB.ORG

Upper Gastrointestinal Bleeding: 6

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Upper Gastrointestinal Bleeding: 6 Clinics and Practice 2011; volume 1:e132 Upper gastrointestinal Introduction Correspondence: Vipul D. Yagnik, 77, Siddhraj bleeding: audit of a single Nagar, Station Road, Patan-384265, Gujarat, center experience in Western Upper gastrointestinal (GI) bleeding is India. Tel. +91.98795.03296. India defined as bleeding proximal to the ligament E-mail: [email protected] of Treitz. The most important aspect of man - Key words: hematemesis, endoscopy, endotherapy. Jignesh B. Rathod, 1 Dharmendra K. Shah, 2 agement of GI bleeding is to locate the site 1 Bhargav D. Yagnik, 3 Vipul D. Yagnik 4 and cause of bleeding. Bleeding from the Received for publication: 7 July 2011. upper GI tract is approximately five times Revision received: 2 November 2011. 1 Department of Surgery, Pramukhswami more common as compared to lower GI tract Accepted for publication: 15 November 2011. Medical College, Karamsad; 2Department bleeding, and males are affected twice as of Surgery, Govt. Medical College, much as compared to females. 2 Clinically, This work is licensed under a Creative Commons Vadodara; 3General Practitioner, upper GI bleeding often presents as Attribution NonCommercial 3.0 License (CC BY- NC 3.0). Ahmedabad; 4Ronak Endo-laparoscopy hematemesis or melena. Fresh blood per rec - Hospital, Patan, Gujarat, India tum (hematochezia) usually indicates lower ©Copyright J.B. Rathod et al., 2011 GI source of bleeding or massive upper GI Licensee PAGEPress, Italy bleeding in 15% of cases and is associated Clinics and Practice 2011; 1:e132 with worse prognosis. 3 About 80% of the GI doi:10.4081/cp.2011.e132 Abstract bleedings stop spontaneously; only 20% con - tinue or recur. Diagnostic accuracy of Upper gastrointestinal (GI) bleeding is endoscopy is 80-95% for upper GI bleeding. 4 defined as bleeding proximal to the ligament National Institute of Health and American Results of Treitz. The most important aspect of man - Society of Gastrointestinal and Endoscopic surgeons 4 recommend urgent endoscopy in a agement of GI bleeding is to locate the site This prospective study was conducted dur - patient who is actively bleeding or has a high and cause of bleeding. The aim of the study is ing the period August 2001-July 2003. Cases risk for re-bleeding (such as old age, shock, were selected randomly and included patients to find out the common etiology, presentation low hemoglobin, melena, more than 4 trans - admitted to both medical as well as surgical and management, including the role of upper fusions, etc.). The aim of the study is to find wards. The total number of cases of upper GI GI endoscopy. Recent advances have meant out the common etiology, presentation and that endoscopic hemostatic methods are now management, including role of upper GI bleeding studied was 50, out of which 37 were associated with a reduced rate of re-bleeding, endoscopy. Recent advances have meant that males and 13 were females. Age distribution is cost, blood transfusion, length of hospital endoscopic hemostatic methods are now shown in Table 1. stay and mortality. A prospective study of 50 associated with a reduced rate of re-bleeding, Patients’ clinical features (symptoms) are summarized in Table 2. Clinical presentation cases was carried out between August 2001 cost, blood transfusion, length of hospital stay and signs are summarized in Table 3. The most and July 2003. Patients with signs and symp - and mortality. 5 We present here the results of common symptom was hematemesis (100%) toms suggestive of upper GI bleeding (UGIB) a prospective study of 50 patients withupper followed by abdominal pain (84%) and melena such as hematemesis, melena, aspirated GI bleeding (UGIB) during the period of 2001- 2003. (28%). The most common sign observed was blood from nasogastric tubes, profuse hema - ascites (18%) followed by shock (14%), and tochezia, etc., were included in the study. hepatosplenomegaly (6%) or splenomegaly The patients were selected randomly. The (6%). Of these, all (100%) patients had most common cause of UGIB in the present Materials and Methods hematemesis while 28% had melena. study was acute erosive gastritis (34%) fol - Out of 50 patients, 10 patients had a history lowed by portal hypertension (24%) and pep - A prospective study of 50 cases was carried of alcoholism while 14 (28%) were smokers. tic ulcer (22%). All 50 patients underwent out between August 2001 and July 2003. This Four patients had a history of upper gastroin - upper GI endoscopy, of whom 39 patients study was conducted in a tertiary care center testinal surgery and 3 patients had a pul - were treated conservatively and 11 patients and medical college in Vadodara (India). This monary tuberculosis with cirrhosis while one underwent endotherapy to control bleeding. study was approved by the university authori - had only pulmonary tuberculosis. Three Out of 39 patients treated non-endoscopical - ties. Written and informed consent was patients were on non-steroidal anti-inflamma - ly, 6 cases required laparotomy to control obtained from the patients /relatives of the tory drugs (NSAIDs). Twelve patients had a UGIB. 8 of 50 cases had past history of UGIB, patients. All patients were selected on the past history of hematemesis (n=8) and 5 of whom had a previous history of basis of a detailed history and physical exami - abdominal pain (n=4). Radiological investigations such as ultra - endotherapy. One case was treated with de- nation. Patients with signs and symptoms sug - sonography (all cases), CT scan (n=6), barium vascularization as routine hemostatic meth - gestive of upper GI bleeding such as hematemesis, melena, blood in the nasogas - study (n=8) and splenoportogram (n=2) were ods failed. So, initial method of choice to con - tric tubes, profuse hematochezia, were includ - carried out in addition to upper GI endoscopy trol the bleeding was endotherapy and sur - ed in the study. The patients were selected ran - to help diagnosis. gery was undertaken if an endoscopic domly. Endoscopy was performed in all patients The etiological distribution is summarized method failed. The most common cause of within 24 h of admission depending upon the in Table 4. In this study, we found that the hematemesis in our setting was acute ero - urgency of the condition by using an Olympus commonest cause of upper GI bleeding was sive gastritis followed by portal hypertension. forward viewing flexible video endoscope. acute erosive gastritis (34%), followed by por - Endoscopy is a valuable minimal invasive Endoscopy was performed by placing the tal hypertension with esophageal varices method to diagnose and treat upper GI bleed - patients in a left lateral position by standard (24%) and peptic ulcer (22%). A few cases had ing. technique. a dual diagnosis, so these were included [page 292 ] [Clinics and Practice 2011; 1:e132] Article under both categories. Table 2. Clinical features. In our study, all patients with portal hyper - Symptom N. patients with symptom (%) tension with esophageal varices were in the 20-50 year age group, while all patients with Hematemesis 50 100 peptic ulcer were in the 20-60 year age group. Pain in abdomen 42 84 Gastric and esophageal cancers were seen in Dysphagia 5 10 patients over 40 years of age. In this study, few patients had a dual diagnosis and both Abnormal behavior or altered sensorium 12 diagnoses were kept in the table. Cause of Melena 14 28 bleeding was decided by recent sign of bleed - Abdominal distension 7 14 ing in such cases. In this study, Hiatus hernia Miscellaneous 16 32 was associated with reflux esophagitis in all The most common presentation was hematemesis followed by abdominal pain, and melena. cases. We were not able to confirm etiology in 2 patients. Among the 50 cases, 44 cases were treated Table 3. Presentation and clinical features. conservatively either by medical therapy (n=33) or by endotherapy (n=11). Six patients Sign N patients (%) underwent surgical treatment. Definite surgi - Shock cal treatment was offered to the patients either Mild 12 to stop persistent bleeding or in case of recur - Moderate 36 rent bleeding (Table 5). Eleven had to undergo Severe (after Wilkinson 1969 )36 immediate endoscopy due to severe and per - Liver failure 12 sistent bleeding from the upper GI tract, while Encephalopathy 12 39 patients underwent endoscopy within 24 h Hepatomegaly 24 (Table 6). All patients were followed for one year. Splenomegaly 36 Endoscopic finding was completely healed in 39 Hepatosplenomegaly 36 patients on subsequent follow up. Three Ascites 9 18 patients of portal hypertension with esophageal varices developed repeat episodes of hematemesis. All 3 patients were treated by Table 4. Endoscopic finding. one more session of endotherapy; no recurrent bleeding was observed in subsequent follow up. S. N. Diagnosis N. (%) During the one year follow up, the operated 1. Acute erosive gastritis 17(34%) case of resected gastric cancer had recurrent upper GI bleeding due to a disease recurrence 2. Portal hypertension with esophageal varices 12(24%) and one patient with esophageal cancer died 3. Peptic ulcer 11(22%) from metastatic disease. 4. Reflux esophagitis 9(18%) 5. Stomal ulceration 4(8%) 6. Hiatus hernia 3(6%) Discussion 7. Esophageal cancer 2(4%) 8. Gastric cancer 2(4%) This prospective study of upper GI bleeding 9. Ulcerated leiomyoma 1(2%) during the period of 2001-2003 was performed 10. Portal hypertension with gastropathy 1(2%) in the SSG Hospital and Medical College, 11. Normal endoscopy 2(4%) Baroda, India. All patients were selected ran - domly. Table 5. Diagnostic versus therapeutic endoscopy. Table 1. Age distribution of patients. Procedure N. cases (%) Age (years) N. of patients Diagnostic endoscopy 39 78% (%) Therapeutic endotherapy 11 22% 21-30 15 30 Total 50 100% 31-40 12 24 41-50 10 20 51-60 10 20 Table 6. Immediate versus within 24 h of endoscopy.
Load more

Recommended publications
  • Clinical Audit on Management of Hematemesis in Children Admitted to Pediatric Gastroenterology and Hepatology Unit of Assiut
    Med. J. Cairo Univ., Vol. 86, No. 8, December: 4531-4536, 2018 www.medicaljournalofcairouniversity.net Clinical Audit on Management of Hematemesis in Children Admitted to Pediatric Gastroenterology and Hepatology Unit of Assiut University Children Hospital ESRAA T. AHMED, M.Sc.; FATMA A. ALI, M.D. and NAGLA H. ABU FADDAN, M.D. The Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt Abstract Hematemesis: Indicates that the bleeding origin is above the Treitz angle, i.e., that it constitutes an Background: Hematemesis is an uncommon but potentially Upper Gastrointestinal Bleeding (UGIB) [3] . serious and life-threatening clinical condition in children. It indicates that the bleeding origin is above the Treitz angle, The etiology of upper GI bleeding varies by i.e., that it constitutes an Upper Gastrointestinal Bleeding (UGIB). age. The pathophysiology of upper GI bleeding is related to the source of the bleeding. Most clinically Aim of Study: To assess for how much the adopted proto- significant causes of upper GI bleeds are associated cols of management of children with upper gastrointestinal bleeding were applied at Gastroenterology & Hepatology Unit with ulcers, erosive esophagitis, gastritis, varices, of Assiut University Children Hospital. and/or Mallory-Weiss tears. While Physiologic Patients and Methods: This study is a an audit on man- stress, NSAIDs such as aspirin and ibuprofen, and agement of children with upper gastrointestinal bleeding infection with Helicobacter pylori are few of the admitted to pediatric Gastroenterology and Hepatology Unit, factors contributing to the imbalance leading to Assiut University Children Hospital during the period from ulcers and erosions in the GI tract [4] .
    [Show full text]
  • Hemosuccus Pancreaticus: a Rare Cause of Upper Gastrointestinal Bleeding During Pregnancy Rani Akhil Bhat,1 Vani Ramkumar,1 K
    Hemosuccus Pancreaticus: A Rare Cause Of Upper Gastrointestinal Bleeding During Pregnancy Rani Akhil Bhat,1 Vani Ramkumar,1 K. Akhil Krishnanand Bhat, 2 Rajgopal Shenoy2 Abstract Upper gastrointestinal bleeding is most commonly caused by From the 1Department of Department of Obstetrics and Gynaecology, Oman Medical 2 lesions in the esophagus, stomach or duodenum. Bleeding which College, Sohar, Sultanate of Oman, Department of Surgery, Oman Medical College, Sohar, Sultanate of Oma. originates from the pancreatic duct is known as hemosuccus pancreaticus. Only a few scattered case reports of hemosuccus Received: 06 Nov 2009 pancreaticus during pregnancy have been recorded in literature. Accepted: 31 Dec 2009 This is a case of a primigravida with 37 weeks of gestation Address correspondence and reprint request to: Dr. Rani A. Bhat,Department of with hemosuccus pancreaticus and silent chronic pancreatitis. Obstetrics and Gynaecology, Oman Medical College, P. O. Box 391, P. C. 321, Al- Evaluating pregnant women with upper gastrointestinal Tareef, Sohar, Sultanate of Oman. bleeding differs from that of non pregnant women as diagnostic E-mail: [email protected] modalities using radiation cannot be used. Therefore, Esophagogastroduodenoscopy should be performed at the time of active bleeding to diagnose hemosuccus pancreaticus. Bhat RA, et al. OMJ. 25 (2010); doi:10.5001/omj.2010.21 Introduction examination showed a combination of dark red blood and melena. Laboratory investigations revealed hemoglobin of 6.3 grams/dL, Hemosuccus pancreaticus is the term used to describe the liver function tests, serum amylase, glucose and prothrombin time syndrome of gastrointestinal bleeding into the pancreatic duct were within the normal range.
    [Show full text]
  • Pheochromocytoma Associated with Renal Agenesis
    Case Report Open Access J Surg Volume 11 Issue 5 - June 2020 Copyright © All rights are reserved by Peterson SJ DOI: 10.19080/OAJS.2020.11.555822 A Rare Cause of Gastrointestinal Bleeding: A Jejunal Dieulafoy’s Lesion Zev Lati1, Karthik Chandrasekaran1, Fastina Khan1, Niel Dave1, Wael El Darawy1, MD Zohirul Islam1 and Stephen J Peterson1,2* 1Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, USA 2Weill Cornell Medical College, USA Received: June 01, 2020; Published: June 24, 2020 *Corresponding author: Peterson SJ, Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, New York, USA Keywords: Gastrointestinal bleed; Dieulafoy’s lesion; Jejunal bleed; End stage renal disease; Immunosuppression; Large granular lymphocytic leukemia Presentation isolated cases associated with chronic immunosuppression One in a thousand people have an acute gastrointestinal whether from underlying malignancies or medication induced (GI) hemorrhage per year [1]. There are around 300,000 [11]. hospitalizations for GI bleeds, costing an estimated $2 billion per year [2-4]. Compared to lower gastrointestinal bleeding (LGIB), More than 70% of these rare lesions are found in the stomach, upper gastrointestinal bleeding (UGIB) is associated with a much usually near the lesser curvature. The discovery of extragastric higher mortality rate, with some studies suggesting a 30-day DFL’s are infrequent, with the duodenum (14%) and colon (5%) mortality rate of up to 14% [2,3]. A majority of these UGIB (67 - being the most common locations [12-14]. The most unusual 80%) are attributed to gastric erosions/ulcers 6,17,18. However, site is the jejunum, which accounts for 1% of all DFL’s [12-14].
    [Show full text]
  • General Anesthesia for GI Endoscopy MP9519
    Coverage of any medical intervention discussed in a WellFirst Health medical policy is subject to the limitations and exclusions outlined in the member's benefit certificate or policy and to applicable state and/or federal laws. General Anesthesia for GI Endoscopy MP9519 Covered Service: Yes Prior Authorization Required: No Additional An appropriate diagnosis code must appear on the claim. Information: Claims will deny in the absence of an appropriate diagnosis code. WellFirst Health Medical Policy: 1.0 Use of general anesthesia may be considered medically necessary for upper or lower gastrointestinal endoscopic procedures when there is documentation by the endoscopist or anesthesiology provider that ANY of these specific risk factors or significant medical conditions are present: 1.1 Prolonged or therapeutic endoscopy procedure is planned and requires deep sedation (e.g. endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), upper gastrointestinal stenting, emergency therapeutic procedures; OR 1.2 Anesthesia Risk Category III or greater based on ASA Physical Status Classification System* when there is increased risk for complication because of severe comorbidity; OR 1.3 Morbid obesity (BMI >40, or BMI >35) with comorbid medical conditions (refractory hypertension, obstructive sleep apnea, coronary heart disease, type 2 diabetes); OR 1.4 Inability to follow simple commands (cognitive dysfunction, intoxication, or psychological impairment); OR 1.5 Spasticity or movement disorder complicating procedure (e.g. epilepsy, seizure disorder); OR 1.6 Persons with anticipated intolerance of standard sedative (e.g. previous problems with anesthesia or sedation, dependence on opiates, sedatives or hypnotics; or drug or alcohol abuse); OR 1.7 Patients who are pregnant; OR All WellFirst Health products and services are provided by subsidiaries of SSM Health Care Corporation, including, but not limited to, SSM Health Insurance Company and SSM Health Plan.
    [Show full text]
  • Case Report: a Patient with Severe Peritonitis
    Malawi Medical Journal; 25(3): 86-87 September 2013 Severe Peritonitis 86 Case Report: A patient with severe peritonitis J C Samuel1*, E K Ludzu2, B A Cairns1, What is the likely diagnosis? 2 1 What may explain the small white nodules on the C Varela , and A G Charles transverse mesocolon? 1 Department of Surgery, University of North Carolina, Chapel Hill NC USA 2 Department of Surgery, Kamuzu Central Hospital, Lilongwe Malawi Corresponding author: [email protected] 4011 Burnett Womack Figure1. Intraoperative photograph showing the transverse mesolon Bldg CB 7228, Chapel Hill NC 27599 (1a) and the pancreas (1b). Presentation of the case A 42 year-old male presented to Kamuzu Central Hospital for evaluation of worsening abdominal pain, nausea and vomiting starting 3 days prior to presentation. On admission, his history was remarkable for four similar prior episodes over the previous five years that lasted between 3 and 5 days. He denied any constipation, obstipation or associated hematemesis, fevers, chills or urinary symptoms. During the first episode five years ago, he was evaluated at an outlying health centre and diagnosed with peptic ulcer disease and was managed with omeprazole intermittently . His past medical and surgical history was non contributory and he had no allergies and he denied alcohol intake or tobacco use. His HIV serostatus was negative approximately one year prior to presentation. On examination he was afebrile, with a heart rate of 120 (Fig 1B) beats/min, blood pressure 135/78 mmHg and respiratory rate of 22/min. Abdominal examination revealed mild distension with generalized guarding and marked rebound tenderness in the epigastrium.
    [Show full text]
  • Esophageal Varices
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Crossref Hindawi Publishing Corporation Case Reports in Critical Care Volume 2016, Article ID 2370109, 4 pages http://dx.doi.org/10.1155/2016/2370109 Case Report A Rare but Reversible Cause of Hematemesis: (Downhill) Esophageal Varices Lam-Phuong Nguyen,1,2,3 Narin Sriratanaviriyakul,1,2,3 and Christian Sandrock1,2,3 1 Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Davis, Suite #3400, 4150 V Street, Sacramento, CA 95817, USA 2Department of Internal Medicine, University of California, Davis, Sacramento, USA 3VA Northern California Health Care System, Mather, USA Correspondence should be addressed to Lam-Phuong Nguyen; [email protected] Received 12 December 2015; Accepted 1 February 2016 Academic Editor: Kurt Lenz Copyright © 2016 Lam-Phuong Nguyen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. “Downhill” varices are a rare cause of acute upper gastrointestinal bleeding and are generally due to obstruction of the superior vena cava (SVC). Often these cases of “downhill” varices are missed diagnoses as portal hypertension but fail to improve with medical treatment to reduce portal pressure. We report a similar case where recurrent variceal bleeding was initially diagnosed as portal hypertension but later found to have SVC thrombosis presenting with recurrent hematemesis. A 39-year-old female with history of end-stage renal disease presented with recurrent hematemesis. Esophagogastroduodenoscopy (EGD) revealed multiple varices.
    [Show full text]
  • Etiology of Upper Gastrointestinal Haemorrhage in a Teaching Hospital
    TAJ June 2008; Volume 21 Number 1 ISSN 1019-8555 The Journal of Teachers Association RMC, Rajshahi Original Article Etiology of Upper Gastrointestinal Haemorrhage in a Teaching Hospital M Uddin Ahmed1, M Abdul Ahad2, M A Alim2, A R M Saifuddin Ekram3, Q Abdullah Al Masum4, Sumona Tanu5, Refaz Uddin6 Abstract A descriptive study on all cases of haematemesis and or melaena was carried out at Rajshahi Medical College Hospital to observe the demographic profile, clinical presentation, cause and outcome of upper gastrointestinal bleeding in a tertiary hospital of Bangladesh. Fifty adult patients presenting with haematemesis and or melaena admitted consecutively into medical unit were evaluated through proper history taking, thorough clinical examination, endoscopic examination with in 48 hours of first presentation and other related investigations. Patients those who were not stabilized haemodynamically with in 48 hours of resuscitation and endoscopy could not be done with in that period were excluded from this study. Results our results showed that out of 50 patients 44 were male and 6 were female and average age of the patients was 39.9 years. Most of the patients were from low socio-economic condition. Farmers, service holders and laborers were the most (57%) affected group. Haematemesis and melaena (42%), only melaena (42%) and only haematemesis (16%) were the presenting features. Endoscopy revealed that duodenal ulcer( 34%) was the most common cause of UGI bleeding followed by rupture of portal varices( 16%) , neoplasm( 10%) , gastric ulcer ( 08%) and gastric erosion( 06%). Acute upper GI bleeding is a common medical problem that is responsible for significant morbidity and mortality.
    [Show full text]
  • Challenges in the Management of Acute Peptic Ulcer Bleeding
    Review Challenges in the management of acute peptic ulcer bleeding James Y W Lau, Alan Barkun, Dai-ming Fan, Ernst J Kuipers, Yun-sheng Yang, Francis K L Chan Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding Lancet 2013; 381: 2033–43 peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the Institute of Digestive Diseases, management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery The Chinese University of Hong continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and Kong, Hong Kong, China (Prof J Y W Lau MD, recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder Prof F K L Chan MD); Division of has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use Gastroenterology, McGill antiplatelet agents, non-steroidal anti-infl ammatory drugs, and anticoagulants. The management of such patients, University and the McGill especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise University Health Centre, Quebec, Canada the published scientifi c literature about the management of patients with bleeding peptic ulcers, identify directions for (Prof A Barkun MD); Institute of future clinical research, and suggest how mortality can be reduced. Digestive Diseases, Xijing Hospital, Fourth Military Introduction by how participants were sampled, their inclusion Medical University, Xian, China (Prof D Fan MD); Department of Acute upper gastrointestinal bleeding is characterised by criteria, and defi nitions of case ascertainment.
    [Show full text]
  • Obscure Gastrointestinal Bleeding in Cirrhosis: Work-Up and Management
    Current Hepatology Reports (2019) 18:81–86 https://doi.org/10.1007/s11901-019-00452-6 MANAGEMENT OF CIRRHOTIC PATIENT (A CARDENAS AND P TANDON, SECTION EDITORS) Obscure Gastrointestinal Bleeding in Cirrhosis: Work-up and Management Sergio Zepeda-Gómez1 & Brendan Halloran1 Published online: 12 February 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose of Review Obscure gastrointestinal bleeding (OGIB) in patients with cirrhosis can be a diagnostic and therapeutic challenge. Recent advances in the approach and management of this group of patients can help to identify the source of bleeding. While the work-up of patients with cirrhosis and OGIB is the same as with patients without cirrhosis, clinicians must be aware that there are conditions exclusive for patients with portal hypertension that can potentially cause OGIB. Recent Findings New endoscopic and imaging techniques are capable to identify sources of OGIB. Balloon-assisted enteroscopy (BAE) allows direct examination of the small-bowel mucosa and deliver specific endoscopic therapy. Conditions such as ectopic varices and portal hypertensive enteropathy are better characterized with the improvement in visualization by these techniques. New algorithms in the approach and management of these patients have been proposed. Summary There are new strategies for the approach and management of patients with cirrhosis and OGIB due to new develop- ments in endoscopic techniques for direct visualization of the small bowel along with the capability of endoscopic treatment for different types of lesions. Patients with cirrhosis may present with OGIB secondary to conditions associated with portal hypertension. Keywords Obscure gastrointestinal bleeding . Cirrhosis . Portal hypertension .
    [Show full text]
  • Endoscopic Diagnosis and Management of Nonvariceal Upper
    Guidelines Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021 Authors Ian M. Gralnek1, 2,AdrianJ.Stanley3, A. John Morris3, Marine Camus4,JamesLau5,AngelLanas6,StigB.Laursen7 , Franco Radaelli8, Ioannis S. Papanikolaou9, Tiago Cúrdia Gonçalves10,11,12,MarioDinis-Ribeiro13,14,HalimAwadie1 , Georg Braun15, Nicolette de Groot16, Marianne Udd17, Andres Sanchez-Yague18, 19,ZivNeeman2,20,JeaninE.van Hooft21 Institutions 17 Gastroenterological Surgery, University of Helsinki and 1 Institute of Gastroenterology and Hepatology, Emek Helsinki University Hospital, Helsinki, Finland Medical Center, Afula, Israel 18 Gastroenterology Unit, Hospital Costa del Sol, 2 Rappaport Faculty of Medicine, Technion-Israel Marbella, Spain Institute of Technology, Haifa, Israel 19 Gastroenterology Department, Vithas Xanit 3 Department of Gastroenterology, Glasgow Royal International Hospital, Benalmadena, Spain Infirmary, Glasgow, UK 20 Diagnostic Imaging and Nuclear Medicine Institute, 4 Sorbonne University, Endoscopic Unit, Saint Antoine Emek Medical Center, Afula, Israel Hospital Assistance Publique Hopitaux de Paris, Paris, 21 Department of Gastroenterology and Hepatology, France Leiden University Medical Center, Leiden, The 5 Department of Surgery, Prince of Wales Hospital, The Netherlands Chinese University of Hong Kong, Hong Kong SAR, China published online 10.2.2021 6 Digestive Disease Services, University Clinic Hospital, University of Zaragoza, IIS Aragón (CIBERehd), Spain Bibliography 7 Department of Gastroenterology, Odense University Endoscopy 2021; 53: 300–332 Hospital, Odense, Denmark DOI 10.1055/a-1369-5274 8 Department of Gastroenterology, Valduce Hospital, ISSN 0013-726X Como, Italy © 2021. European Society of Gastrointestinal Endoscopy 9 Hepatogastroenterology Unit, Second Department of All rights reserved. Internal Medicine – Propaedeutic, Medical School, This article ist published by Thieme.
    [Show full text]
  • Defining and Measuring Quality in Endoscopy
    Communication from the ASGE QUALITY INDICATORS FOR Quality Assurance in Endoscopy Committee GI ENDOSCOPIC PROCEDURES Defining and measuring quality in endoscopy Quality has been a key focus for gastroenterology, The expert panels that were convened in 2005 compiled a driven by a common desire to promote best practices list of quality indicators that were deemed, at the time, to be among gastroenterologists and to foster evidence-based both feasible to measure and associated with improved pa- care for our patients. The movement to define and then tient outcomes. Feasibility concerns precluded measures measure aspects of quality for endoscopy was sparked by that required data collection after the date of endoscopy ser- public demand arising from alarming reports about medi- vice. Accordingly, the majority of the initial indicators con- cal errors. Two landmark articles published in 2000 and sisted of process measures, often related to documentation 2001 led to a national imperative to address perceived of important parameters in the endoscopy note. The evi- areas of underperformance and variations in care across dence demonstrating a link between these indicators to many fields of medicine.1,2 Initial efforts to designate and improved outcomes was limited. In many instances, the require reporting a small number of basic outcome mea- 2005 task force relied on expert opinion. Setting perfor- sures were mandated by the Centers for Medicare & mance targets based on community benchmarks was intro- Medicaid Services, and the process to develop perfor- duced, yet there was significant uncertainty about standard mance measures for government reporting and “pay for levels of performance. Reports citing performance data often performance” programs was initiated.
    [Show full text]
  • Hematemesis and Melena Chapter
    126 CHAPTER 20 Hematemesis and melena Anthony Y. B. Teoh and James Y. W. Lau Chinese University of Hong Kong, Hong Kong SAR, China ESSENTIAL FACTS ABOUT CAUSATION ESSENTIALS OF TREATMENT Algorithm for management of acute GI bleeding Diagnosis Number of patients Mortality (%) 200716 (%) Major bleeding Minor bleeding Ulcer 1826 (27) 162 (8.9) (unstable hemodynamics) Erosive disease (gastric 1731 (26) 195 (14.1) Early elective upper and duodenum) Active resuscitation endoscopy Esophagitis 1177 (17) 65 (5.5) Urgent endoscopy Varices and portal 819 (12) 87 (14) Early administration of vasoactive hypertensive drugs in suspected variceal bleeding gastropathy Active ulcer bleeding Bleeding varices Malignancy 187 (3) 31 (17) Major stigmata Mallory-Weiss 213 (3) 10 (4.7) Endoscopic therapy Endoscopic therapy Adjunctive PPI Adjunctive vasoactive syndrome drugs Other diagnosis 797 (12) 125 (16) Success Failure Success Failure Continue Continue ulcer healing Recurrent Total 6750 675 (10) vasoactive drugs medications bleeding Variceal Data adapted from The United Kingdom National Audit in Upper Repeat endoscopic eradication Gastrointestinal Bleeding 2007 [16]. therapy program Sengstaken- Success Failure Blakemore tube ESSENTIALS OF DIAGNOSIS Angiographic embolization TIPS vs vs. surgery surgery • Symptoms: Coffee ground vomiting, hematemesis, melena, hematochezia, anemic symptoms • Past medical history: Liver cirrhosis, use of non-steroidal anti- inflammatory drugs • Signs: Hypotension, tachycardia, pallor, altered mental status, and therapeutic tool in managing these patients. Stratification melena or blood per rectum, decreased urine output of the patients into low- or high-risk groups aids in formulat- • Bloods: Anemia, raised urea, high urea to creatinine ratio • Endoscopy: Ulcers, varices, Mallory-Weiss tear, erosive disease, ing a clinical management plan and early endoscopy with neoplasms, vascular ectasia, and vascular malformations aggressive post-hemostasis care should be provided in high- risk patients.
    [Show full text]