Upper gastrointestinal bleeding
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| Sprache: | English |
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Philadelphia, Pa.
Elsevier
2014
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| Schriftenreihe: | Gastroenterology clinics of North America
43,4 |
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| 245 | 1 | 0 | |a Upper gastrointestinal bleeding |c ed. Ian M. Gralnek |
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| 300 | |a XVI S., S. 643 - 856 |b Ill. | ||
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Datensatz im Suchindex
| _version_ | 1819586978163720192 |
|---|---|
| adam_text | Titel: Upper gastrointestinal bleeding
Autor: Gralnek, Ian M
Jahr: 2014
Upper Gastrointestinal Bleeding
Contents
Foreword: Upper Gl Bleeding xiii
Gary W. Falk
Preface: Upper Gl Bleeding xv
Ian M. Gralnek
Epidemiology and Diagnosis of Acute Nonvariceal Upper Gastrointestinal Bleeding 643
Gianluca Rotondano
Acute upper gastrointestinal bleeding (UGIB) is a common gastroentero-
logical emergency. A vast majority of these bleeds have nonvariceal
causes, in particular gastroduodenal peptic ulcers. Nonsteroidal antiin-
flammatory drugs, low-dose aspirin use, and Helicobacter pylori infection
are the main risk factors for UGIB. Current epidemiologic data suggest that
patients most affected are older with medical comorbidit. Widespread use
of potentially gastroerosive medications underscores the importance of
adopting gastroprotective pharmacologic strategies. Endoscopy is the
mainstay for diagnosis and treatment of acute UGIB. It should be per-
formed within 24 hours of presentation by skilled operators in adequately
equipped settings, using a multidisciplinary team approach.
Upper Gastrointestinal Bleeding: Patient Presentation, Risk Stratification,
and Early Management 665
Andrew C. Meitzer and Joshua C. Klein
The established quality indicators for early management of upper gastro-
intestinal (Gl) hemorrhage are based on rapid diagnosis, risk stratification,
and early management. Effective preendoscopic treatment may improve
survivability of critically ill patients and improve resource allocation for all
patients. Accurate risk stratification helps determine the need for hospital
admission, hemodynamic monitoring, blood transfusion, and endoscopic
hemostasia before esophagogastroduodenoscopy (EGO) via indirect mea-
sures such as laboratory studies, physiologic data, and comorbidities.
Early management before the definitive EGO is essential to improving
outcomes for patients with upper Gl bleeding.
Endoscopic Management of Acute Peptic Ulcer Bleeding 677
Yidan Lu, Yen-I Chen, and Alan Barkun
This review discusses the indications, technical aspects, and comparative
effectiveness of the endoscopic treatment of upper gastrointestinal
bleeding caused by peptic ulcer. Pre-endoscopic considerations, such
as the use of prokinetics and timing of endoscopy, are reviewed. In addi-
tion, this article examines aspects of postendoscopic care such as the
effectiveness, dosing, and duration of postendoscopic proton-pump in-
hibitors, Helicobacter pylori testing, and benefits of treatment in terms of
preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs,
antiplatelet agents, and oral anticoagulants, including direct thrombin and
Xa inhibitors, following acute peptic ulcer bleeding.
viii Contents
Endoscopie Management of Nonvariceal, Nonulcer Upper Gastrointestinal Bleeding 707
Eric T.T.L. Tjwa, I. Lisanne Holster, and Ernst J. Kuipers
Upper gastrointestinal bleeding (UGIB) is the most common emergency
condition in gastroenterology. Although peptic ulcer and esophagogastric
varices are the predominant causes, other conditions account for up to
50% of UGlBs. These conditions, among others, include angiodysplasia,
Dieulafoy and Mallory-Weiss lesions, gastric antral vascular ectasia, and
Cameron lesions. Upper Gl cancer as well as lesions of the biliary tract
and pancreas may also result in severe UGIB. This article provides an
overview of the endoscopic management of these lesions, including the
role of novel therapeutic modalities such as hemostatic powder and
over-the-scope-clips.
Emerging Endoscopic Therapies for Nonvariceal Upper Gastrointestinal Bleeding 721
Louis M. Wong Kee Song and Michael J. Levy
Videos of hemostasis of an actively bleeding gastric Dieulafoy
lesion, hemostasis of an actively bleeding duodenal ulcer, carbon
dioxide-based cryotherapy of diffuse gastric antral vascular ectasia,
radiofrequency ablation of gastric antral vascular ectasia, animation
of the OverStitch endoscopic suturing device, and OverStitch suture
closure of endoscopic submucosal dissection defect accompany
this article
Several new devices and innovative adaptations of existing modalities
have emerged as primary, adjunctive, or rescue therapy in endoscopic
hemostasis of gastrointestinal hemorrhage. These techniques include
over-the-scope clip devices, hemostatic sprays, cryotherapy, radiofre-
quency ablation, endoscopic suturing, and endoscopic ultrasound-guided
angiotherapy. This review highlights the technical aspects and clinical
applications of these devices in the context of nonvariceal upper gastroin-
testinal bleeding.
What if Endoscopic Hemostasis Fails?: Alternative Treatment Strategies:
Interventional Radiology 739
Sujal M. Nanavati
Since the 1960s, interventional radiology has played a role in the manage-
ment of gastrointestinal bleeding. What began primarily as a diagnostic
modality has evolved into much more of a therapeutic tool. And although
the frequency of gastrointestinal bleeding has diminished thanks to
management by pharmacologic and endoscopic methods, the need for
additional invasive interventions still exists. Transcatheter angiography
and intervention is a fundamental step in the algorithm for the treatment
of gastrointestinal bleeding.
What If Endoscopic Hemostasis Fails?: Alternative Treatment Strategies: Surgery 753
Philip Wai Yan Chiù and James Yun Wong Lau
Management of bleeding peptic ulcers is increasingly challenging in an
aging population. Endoscopic therapy reduces the need for emergency
Contents ix
surgery in bleeding peptic ulcers. Initial endoscopic control offers an oppor-
tunity for selecting high-risk ulcers for potential early preemptive surgery.
However, such an approach has not been supported by evidence in the
literature. Endoscopic retreatment can be an option to control ulcer rebleed-
ing and reduce complications. The success of endoscopic retreatment
largely depends on the severity of rebleeding and ulcer characteristics.
Large chronic ulcers with urgent bleeding are less likely to respond to
endoscopic retreatment. Expeditious surgery is advised.
Epidemiology, Diagnosis and Early Patient Management of Esophagogastric
Hemorrhage 765
Sumit Kumar, Sumeet K. Asrani, and Patrick S. Kamath
Acute variceal bleeding (AVB) is a potentially life-threatening complication
of cirrhosis and portal hypertension. Combination therapy with vasoactive
drugs and endoscopic variceal ligation is the first-line treatment in the
management of AVB after adequate hemodynamic resuscitation. Short-
term antibiotic prophylaxis, early resuscitation, early use of lactulose for
prevention of hepatic encephalopathy, targeting of conservative goals
for blood transfusion, and application of early transjugular intrahepatic
portosystemic shunts in patients with AVB have further improved the
prognosis of AVB. This article discusses the epidemiology, diagnosis,
and nonendoscopic management of AVB.
Primary Prophylaxis of Variceal Bleeding 783
Jawad A. Ilyas and Fasiha Kanwal
Gastroesophageal varices are present in almost half of patients with
cirrhosis at the time of initial diagnosis. Variceal bleeding occurs in 25%
to 35% of patients with cirrhosis. Effective and timely care can prevent
variceal bleeding (primary prophylaxis). For example, clinical studies de-
monstrate that both beta-blockers and endoscopic variceal ligation are
effective in preventing a first episode of variceal bleeding. The major chal-
lenge is to screen patients in a timely manner and institute a form of ther-
apy that has the highest chance of success in terms of patient compliance
and effectiveness.
Endoscopic Hemostasis in Acute Esophageal Variceal Bleeding 795
Andres Cardenas, Anna Baiges, Virginia Hernandez-Gea, and
Juan Carlos Garcia-Pagan
Acute variceal bleeding (AVB) is a milestone event for patients with portal
hypertension. Esophageal varices bleed because of an increase in portal
pressure that causes the variceal wall to rupture. AVB in a patient with
cirrhosis and portal hypertension is associated with significant morbidity
and mortality. The initial management of these patients includes proper
resuscitation, antibiotic prophylaxis, pharmacologic therapy with vaso-
constrictors, and endoscopic therapy. Intravascular fluid management,
timing of endoscopy, and endoscopic technique are key in managing
these patients. This article reviews the current endoscopic hemostatic
strategies for patients with AVB.
x Contents
Endoscopie Management of Gastric Variceal Bleeding 807
Frank Weilert and Kenneth F. Binmoeller
Expert knowledge of endoscopic management of gastric varices is essen-
tial, as these occur in 20% of patients with portal hypertension. Bleeding is
relatively uncommon, but carries significant mortality when this occurs.
Inability to directly target intravascular injections and the potential compli-
cation related to glue embolization has resulted in the development of
novel techniques. Direct visualization of the varix lumen using endoscopic
ultrasound (EUS) allows targeted therapy of feeder vessels with real-time
imaging. EUS-guided combination therapy with endovascular coiling and
cyanoacrylate injections promise to provide reduced complication rates,
increased obliteration of varices, and reduced long-term rebleeding rates.
Nonendoscopic Management Strategies for Acute Esophagogastric Variceal
Bleeding 819
Sanjaya K. Satapathy and Arun J. Sanyal
Acute variceal bleeding is a potentially life-threatening complication of
portal hypertension. Management consists of emergent hemostasia, ther-
apy directed at hemodynamic resuscitation, protection of the airway, and
prevention and treatment of complications including prophylactic use of
antibiotics. Endoscopic treatment remains the mainstay in the manage-
ment of acute variceal bleeding in combination with pharmacotherapy
aimed at reducing portal pressure. This article intends to highlight only
the current nonendoscopic treatment approaches for control of acute
variceal bleeding.
Approach to the Management of Portal Hypertensive Gastropathy and
Gastric Antral Vascular Ectasia 835
Kamran Qureshi and Abdullah M.S. Al-Osaimi
Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy
(PHG) are important causes of chronic gastrointestinal bleeding. These
gastric mucosal lesions are mostly diagnosed on upper endoscopy and
can be distinguished based on their appearance or location in the stom-
ach. In some situations, especially in patients with liver cirrhosis and portal
hypertension, a diffuse pattern and involvement of gastric mucosa are
seen with both GAVE and severe PHG. The diagnosis in such cases is
hard to determine on visual inspection, and thus, biopsy and histologic
evaluation can be used to help differentiate GAVE from PHG.
Index
849
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| title | Upper gastrointestinal bleeding |
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| title_fullStr | Upper gastrointestinal bleeding ed. Ian M. Gralnek |
| title_full_unstemmed | Upper gastrointestinal bleeding ed. Ian M. Gralnek |
| title_short | Upper gastrointestinal bleeding |
| title_sort | upper gastrointestinal bleeding |
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