Upper GI and Ulcer Bleeding

Question 1

Suggest that patients presenting to the emergency department w/ UGIB who are classified as very low risk, defined as a risk assessment score w/ </= 1% false negative rate for the outcome of hospital-based intervention or death (ie: Glasgow-Blatchford score = 0-1), be discharged w/ outpatient follow-up rather than admitted to hospital

Answer 1

conditional, very low evidence

Question 2

Suggest a restrictive policy of RBC transfusion w/ a threshold for transfusion at a hemoglobin of 7 g/dL for patients w/ UGIB

Answer 2

conditional, low evidence

Question 3

Suggest an infusion or erythromycin before endoscopy in patients w/ UGIB

Answer 3

conditional, very low evidence

Question 4

We could not reach a recommendation for or against pre-endoscopic PPI therapy for patients w/ UGIB

Answer 4

N/A

Question 5

Suggest that patients admitted to or under observation in hospital for UGIB undergo endoscopy within 24 hr of presentation

Answer 5

conditional, very low evidence

Question 6

Recommend endoscopic therapy in patients w/ UGIB due due to ulcers w/ active spurting, active oozing, and non bleeding visible vessels

Answer 6

strong, moderate evidence

Question 7

We could not reach a recommendation for or against endoscopic therapy in patients w/ UGIB due to ulcers w/ adherent clot resistant to vigorous irrigation

Answer 7

N/A

Question 7

Recommend endoscopic hemostatic therapy w/ bipolar electrocoagulation, heater probe, or injection of absolute ethanol for patients w/ UGIB due to ulcers

Answer 7

strong, moderate evidence

Question 7

Suggest endoscopic hemostatic therapy w/ clips, argon plasma coagulation, or soft monocular electrocoagulation for patients w/ UGIB due to ulcers

Answer 7

conditional, very low to low evidence

Question 8

Recommend that epinephrine injection not be used alone for patients w/ UGIB due to ulcers but rather in combination w/ another hemostatic modality

Answer 8

strong, very low to moderate evidence

Question 9

Suggest endoscopic hemostatic therapy w/ hemostatic powder spray TC-325 for patients w/ actively bleeding ulcers

Answer 9

conditional, very low evidence

Question 10

Suggest over-the-scope clips as a hemostatic therapy for patients who develop recurrent bleeding due to ulcers after previous successful endoscopic hemostasis

Answer 10

conditional, low evidence

Question 11

Recommend high-dose PPI therapy given continuously or intermittently for 3 d after successful endoscopic hemostatic therapy of a bleeding ulcer

Answer 11

strong, moderate to high evidence

Question 12

Suggest that high-risk patients w/ UGIB due to ulcers who received endoscopic hemostatic therapy followed by short-term high-dose PPI therapy in hospital continue on twice-daily PPI therapy until 2 wk after index endoscopy

Answer 12

conditional, low evidence

Question 13

Suggest that patients w/ recurrent bleeding after endoscopic therapy for a bleeding ulcer undergo repeat endoscopy and endoscopic therapy rather than undergo surgery or trans catheter arterial embolization

Answer 13

conditional, low evidence

Question 14

Suggest patients w/ bleeding ulcers who have failed endoscopic therapy next be treated w/ transcatheter arterial embolization

Answer 14

conditional, very low evidence