Kevin A Ghassemi1,2, Dennis M Jensen3,4,5. 1. Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza #205, Los Angeles, CA, 90095, USA. kghassemi@mednet.ucla.edu. 2. CURE Digestive Diseases Research Center, Los Angeles, USA. kghassemi@mednet.ucla.edu. 3. Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza #205, Los Angeles, CA, 90095, USA. 4. CURE Digestive Diseases Research Center, Los Angeles, USA. 5. Department of Medicine, West Los Angeles VA Medical Center, Los Angeles, USA.
Abstract
PURPOSE OF REVIEW: There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ulcers, Dieulafoy lesions, and Mallory-Weiss tears), including the use of the Doppler endoscopic probe (DEP). RECENT FINDINGS: Prospective studies evaluating the use of DEP in non-variceal UGI hemorrhage showed that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared to those with intermediate-risk SRH. Additionally, lesions with a persistently positive DEP signal after endoscopic hemostasis were seen with high-risk SRH and had a higher 30-day rebleeding rate. Residual arterial blood flow underneath ulcers is a significant risk factor for rebleeding. However, if more endoscopic treatment is applied, clinical outcomes for patients with severe non-variceal UGI hemorrhage are improved, as documented by a recent CURE Hemostasis randomized controlled trial (RCT).
PURPOSE OF REVIEW: There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ulcers, Dieulafoy lesions, and Mallory-Weiss tears), including the use of the Doppler endoscopic probe (DEP). RECENT FINDINGS: Prospective studies evaluating the use of DEP in non-variceal UGI hemorrhage showed that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared to those with intermediate-risk SRH. Additionally, lesions with a persistently positive DEP signal after endoscopic hemostasis were seen with high-risk SRH and had a higher 30-day rebleeding rate. Residual arterial blood flow underneath ulcers is a significant risk factor for rebleeding. However, if more endoscopic treatment is applied, clinical outcomes for patients with severe non-variceal UGI hemorrhage are improved, as documented by a recent CURE Hemostasis randomized controlled trial (RCT).
Authors: Dennis M Jensen; Gordon V Ohning; Thomas O G Kovacs; Kevin A Ghassemi; Rome Jutabha; Gareth S Dulai; Gustavo A Machicado Journal: Gastrointest Endosc Date: 2015-08-28 Impact factor: 9.427
Authors: R C Wong; A Chak; K Kobayashi; G A Isenberg; G S Cooper; D L Carr-Locke; M V Sivak Journal: Gastrointest Endosc Date: 2000-09 Impact factor: 9.427
Authors: Alan N Barkun; Marc Bardou; Ernst J Kuipers; Joseph Sung; Richard H Hunt; Myriam Martel; Paul Sinclair Journal: Ann Intern Med Date: 2010-01-19 Impact factor: 25.391