Upper non-variceal gastrointestinal bleeding - review the effectiveness of endoscopic hemostasis methods

Table 1 Blatchford scoring: Admission risk markers and associated score component values[13]

Admission risk marker	Score component value
Blood urea, mmol/L
6.5 to ≤ 8	2
8.0 to < 10.0	3
10.0 to < 25	4
≥ 25	6
Hemoglobin for men, g/dL
12.0-13.0	1
10.0 to < 12.0	3
< 10.0	6
Hemoglobin for women, g/dL
10.0 to < 12.0	1
10	6
Systolic blood pressure, mmHg
100-109	1
90-99	2
< 90	3
Other markers
Pulse ≥ 100/min	1
Presentation with melena	1
Presentation with syncope	2
Hepatic disease	2
Cardiac failure	2

Table 2 Complete rockall risk scoring system for assessment after an episode of acute upper gastrointestinal bleeding[12]

Variables	Score 0	Score 1	Score 2	Score 3
Age	Younger than 60 yr	60-79 yr	80 yr or older	-
Shock symptoms, systolic blood pressure, heart rate	Shock absent, blood pressure 100 mmHg or greater, heart rate 100 bpm or greater	Tachycardia, blood pressure 100 mmHg or greater, heart rate 100 bpm or greater	Hypotension, blood pressure less than 100 mmHg	-
Comorbidities	No major comorbidity	-	Heart failure, coronary artery disease, any major comorbidity	Renal failure, liver failure, disseminated malignancy
Endoscopic diagnosis	Mallory-Weiss tear or no lesion identified, and no stigmata of recent hemorrhage	All other diagnoses	Malignancy of upper GI tract	-
Stigmata of recent hemorrhage	Low-risk	-	High-risk	-

Low-risk stigmata of bleeding: Clean base ulcer, pigmented spots; High-risk stigmata of bleeding: Adherent clot, visible or spurting vessel, active bleeding; Bpm: Beats per minute; GI: Gastrointestinal.

Table 3 Recommendations of the american society for gastrointestinal endoscopy concerning upper gastrointestinal bleeding management[38]

We recommend that patients with UGIB be adequately resuscitated before endoscopy

We recommend antisecretory therapy with PPIs for patients with bleeding caused by peptic ulcers or in those with suspected peptic ulcer bleeding awaiting endoscopy

We suggest prokinetic agents in patients with a high probability of having fresh blood or a clot in the stomach when undergoing endoscopy

We recommend endoscopy to diagnose the etiology of acute UGIB. The timing of endoscopy should depend on clinical factors. Urgent endoscopy (within 24 h of presentation) is recommended for patients with a history of malignancy or cirrhosis, presentation with hematemesis, and signs of hypovolemia including hypotension, tachycardia and shock, and a hemoglobin < 8 g/dL

We recommend endoscopic therapy for peptic ulcers with high-risk stigmata (active spurting, visible vessel). The management of PUD with an adherent clot is controversial. Recommended endoscopic treatment modalities include injection (sclerosants, thrombin, fibrin, or cyanoacrylate glue), cautery, and mechanical therapies

We recommend against epinephrine injection alone for peptic ulcer bleeding. If epinephrine injection is performed, it should be combined with a second endoscopic treatment modality (e.g., cautery or clips)

We recommend that patients with low-risk lesions be considered for outpatient management

We recommend against routine second-look endoscopy in patients who have received adequate endoscopic therapy

We recommend repeat endoscopy for patients with evidence of recurrent bleeding

UGIB: Upper gastrointestinal bleeding; PPIs: Proton pump inhibitors; PUD: Peptic ulcer disease.