Gastrointestinal Bleeding: Update

Abstract

In suspected gastrointestinal bleeding (GIB), standard operating procedures help in risk stratification, early patient management and endoscopy. If variceal bleeding is suspected, specific medication (vasoconstrictors, antimicrobial therapy) are additive to standard pharmacological management (PPI, erythromycin) prior to endoscopy. An emergency endoscopy can be performed independent of the patient's current coagulation status. Endoscopic management remains the diagnostic and therapeutic standard in GIB. Propofol can be saafely used for emergency endoscopy. Injection therapy should be combined with mechanical or thermal therapy. Recent data suggests good efficacy of novel options (over-the-scope clips, hemostatic powder, stent compression) in defined clinical situations. Biopsies can usually be obtained during index endoscopy. In severe lower GIB, early colonoscopy after intensified bowel lavage is mandated to localize bleeding. In high risk patients, insertion of a covered TIPS should be considered. In refractory or recurrent bleeding, stent insertion or balloon compression help to bridge the time for TIPS preparation.