Gastrointestinal bleeding

For this year’s Endoscopy Essentials installment of gastrointestinal bleeding, we have selected important papers in the field of nonvariceal and variceal-related digestive bleeding. Many questions regarding the general and endoscopic management of these patients have remained, up to now, unanswered. The past year has been very prolific in providing us with good-quality randomized trials as well as well-conducted meta-analyses in hot topics in the field. We hope that these studies, will eventually clarify and standardize the management of patients with digestive bleeding and promote new fields of research in endoscopy.

References

• 1 Lau J Y, Leung W K, Wu J CY. et al . Omeprazole before endoscopy in patients with gastrointestinal bleeding.  N Engl J Med. 2007;  356 1631-1640
• 2 Lau J Y, Sung J J, Lee K K. et al . Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers.  N Engl J Med. 2000;  343 310-316
• 3 Leontiadis G I, Sharma V K, Howden C W. Proton pump inhibitor treatment for acute peptic ulcer bleeding.  Cochrane Database Syst Rev. 2006;  CD002094
• 4 Barkun A N, Herba K, Adam V. et al . The cost-effectiveness of high-dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding.  Aliment Pharmacol Ther. 2004;  20 195-202
• 5 Green Jr F W, Kaplan M M, Curtis L E, Levine P H. Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage.  Gastroenterology. 1978;  74 38-43
• 6 Patchett S E, O’Donoghue D P. Pharmacological manipulation of gastric juice: thrombelastographic assessment and implications for treatment of gastrointestinal haemorrhage.  Gut. 1995;  36 358-362
• 7 Sung J JY, Tsoi K KF, Lai L H. et al . Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis.  Gut. 2007;  56 1364-1373
• 8 Cook D J, Guyatt G H, Salena B J, Laine L A. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.  Gastroenterology. 1992;  102 139-148
• 9 Calvet X, Vergara M, Brullet E. et al . Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers.  Gastroenterology. 2004;  126 441-450
• 10 Marmo R, Rotondano G, Piscopo R. et al . Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials.  Am J Gastroenterol. 2007;  102 279-289
• 11 Vergara M, Calvet X, Gisbert J P. Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers.  Cochrane Database of Systematic Reviews. 2007;  2 1-35
• 12 Bambha K, Kim W R, Pedersen R. et al . Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis.  Gut. 2008;  57 814-820
• 13 McCormick P A, O’Keefe C. Improving prognosis following a first variceal haemorrhage over four decades.  Gut. 2001;  49 682-685
• 14 de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension.  J Hepatol. 2005;  43 167-176
• 15 Amitrano L, Guardascione M A, Bennato R. et al . MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices.  J Hepatol. 2005;  42 820-825
• 16 Chalasani N, Kahi C, Francois F. et al . Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding.  Hepatology. 2002;  35 1282-1284
• 17 D’Amico G, Garcia-Pagan J C, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review.  Gastroenterology. 2006;  131 1611-1624
• 18 Albillos A, Banares R, Gonzalez M. et al . Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis.  Am J Gastroenterol. 2007;  102 1116-1126
• 19 Gonzalez R, Zamora J, Gomez-Camarero J. et al . Meta-analysis: combination endoscopic and drug therapy to prevent variceal rebleeding in cirrhosis.  Ann Iintern Med. 2008;  149 109-122
• 20 Bosch J, Garcia-Pagan J C. Prevention of variceal rebleeding.  Lancet. 2003;  361 952-954