Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding

Abstract

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common medical emergency in clinical practice. While the incidence has significantly reduced, the mortality rates have not undergone a similar reduction in the last few decades, thus presenting a significant challenge. This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis. Since ANUVGIB predominantly affects the elderly population, the impact of comorbidities may be responsible for the poor outcomes. A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly. Early risk stratification plays a crucial role in deciding the line of management and predicting mortality. Emerging scoring systems such as the ABC (age, blood tests, co-morbidities) score show promise in predicting mortality and guiding clinical decisions. While conventional endoscopic therapies remain cornerstone approaches, novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives, particularly in cases refractory to traditional modalities. By integrating validated scoring systems and leveraging novel therapeutic modalities, clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.

Keywords: Non-variceal upper gastrointestinal bleeding; Upper gastrointestinal bleeding; Gastrointestinal bleeding; Risk stratification; Risk assessment scores; Prognostication; Endoscopy; Esophagogastroduodenoscopy; Endoscopic hemostasis

Core Tip: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) presents a significant medical challenge. Despite advancements in management, mortality remains high in the context of an increasingly elderly, comorbid population. While early risk stratification using established scoring systems ensures targeted management, newer scoring systems show promise in predicting mortality and should be integrated into medical practice after proper validation. Novel endoscopic techniques offer promising alternatives, especially in cases where conventional modalities are ineffective. By integrating validated scoring systems and adopting innovative therapeutic modalities, clinicians can enhance patient care and mitigate the substantial mortality associated with ANVUGIB.