Upper Endoscopy Evaluation of GI Bleeding

Aka: Upper Endoscopy Evaluation of GI Bleeding, Upper GI Endoscopic Evaluation of Bleeding, Esophagogastroduodenoscopy in GI Bleeding, EGD Findings in Upper GI Bleeding, Upper Gastrointestinal Bleeding Evaluation with Esophagogastroduodenoscopy, Gastrointestinal Bleeding Evaluation with Upper Endoscopy

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II. Indications

  1. Upper GI Bleeding
  2. See Upper GI Bleeding Score

III. Preparation

  1. Consider Erythromycin 250 mg IV before endoscopy
    1. May allow better visualization if active bleeding
    2. Does not alter rate of identifying lesion
    3. Sears (1996) Gastrointest Endosc 43:A269 [PubMed]

IV. Techniques: Measures used to coagulate bleeding sites

  1. Indications: Active Upper Gastrointestinal Bleeding site
    1. Peptic Ulcer bleeding
    2. Arteriovenous Malformation
    3. Mallory-Weiss tear
    4. Dieulafoy Ulcer
  2. Efficacy
    1. All methods appear to be equally efficacious
    2. Many endoscopists both inject and coagulate lesions
  3. Thermal Contact
    1. Heater probe
    2. Multipolar electrocoagulation
  4. Surgical Clips
    1. Endoclips
  5. Bleeding site injection (typically combined with other measures)
    1. Epinephrine injection
    2. Alcohol injection (sclerosing agent)
      1. Higher risk of perforation
  6. Laser (rarely used)
    1. Nd:YAG Laser
    2. Argon Laser

V. Interpretation: Low Risk Findings

  1. Ulcer with clean base under 2 cm (5% rebleeding risk)
  2. Nonbleeding Mallory-Weiss Tear
  3. Esophagitis
  4. Gastritis
  5. Duodenitis
  6. Endoscopy negative for any lesion or fresh blood
    1. Failure to find source only adverse in over age 80
    2. Otherwise not related to adverse risk

VI. Interpretation: Moderate risk findings

  1. Ulcer with clean base over 2 cm in diameter
  2. Ulcer with clot or pigmented spot (10% risk of rebleed)
  3. Bleeding Mallory-Weiss tear with effective treatment
  4. Arteriovenous Malformation with successful treatment
  5. Portal gastropathy without Esophageal Varices
  6. Tumor identified on endoscopy
  7. Higher risk ulcer location
    1. Ulcer on lesser curvature of the Stomach
    2. Ulcer on posterior duodenal bulb

VII. Interpretation: High risk findings

  1. Actively bleeding ulcer or other bleeding lesion (12% Prevalence)
    1. Rebleeding rate without endoscopic treatment: 90%
    2. Rebleeding rate with successful endoscopic treatment: 15-30%
  2. Vessel visible on endoscopy (22% Prevalence)
    1. Rebleeding rate without endoscopic treatment: 50%
    2. Rebleeding rate with successful endoscopic treatment: 15-30%
  3. Adherent clot (10% Prevalence)
    1. Rebleeding rate without endoscopic treatment: 33%
    2. Rebleeding rate with successful endoscopic treatment: 5%
  4. Esophageal Varices with active bleeding

VIII. Management: Post-procedure

  1. Rebleeding occurs in 20% of cases despite treatment and requires repeat endoscopy
  2. Second-look endoscopy in 24 hours may be recommended
  3. Failed attempt to stop bleeding
    1. See Upper Gastrointestinal Bleeding
    2. Arteriography with embolization
    3. Surgery for severe ongoing bleeding

IX. References

  1. Forrest (1974) Lancet 2(7877): 394-7 [PubMed]
  2. Terdiman (1998) Postgrad Med 103(6):43-64 [PubMed]
  3. Fallah (2000) Med Clin North Am 84(5):1183-208 [PubMed]
  4. Zimmerman (1995) Scand J Gastroenterol 30(4): 327-31 [PubMed]

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Related Studies

Ontology: Upper gastrointestinal hemorrhage (C0041909)

Definition (NCI_CTCAE) A disorder characterized by bleeding from the upper gastrointestinal tract (oral cavity, pharynx, esophagus, and stomach).
Definition (NCI) Bleeding originating from the upper gastrointestinal tract (oral cavity, pharynx, esophagus, and stomach).
Concepts Pathologic Function (T046)
SnomedCT 197474003, 37372002
English Upper GI-gastrointes haemorrh, Upper gastrointest haemorrhage, Upper gastrointest hemorrhage, Upper gastrointestinal hemorrhage, upper gastrointestinal bleeding (diagnosis), upper gastrointestinal bleeding, upper GI bleeding, UGI bleed, Upper GI blood loss, Upper Gastrointestinal Hemorrhage, bleed ugi, bleeds ugi, ugi bleed, upper gastrointestinal bleed, upper gi bleeding, bleeds gi upper, bleeding gi upper, gi haemorrhage upper, upper gi hemorrhage, upper gi bleed, upper gi haemorrhage, bleed gastrointestinal upper, bleeding gastrointestinal upper, bleeding ugi, bleed gi upper, Upper gastrointestinal haemorrhage (disorder), Upper GI bleeding, Upper gastrointestinal bleeding, Upper GI - gastrointestinal haemorrhage, Upper GI - gastrointestinal hemorrhage, Upper gastrointestinal haemorrhage, Upper GI haemorrhage, Upper GI hemorrhage, Upper gastrointestinal hemorrhage (disorder)
Italian Emorragia del tratto gastrointestinale superiore, Sanguinamento del tratto gastrointestinale superiore
Dutch bovenste maagdarmkanaalbloedverlies, bloeding van bovenste deel van maag-darmkanaal, bovenste maagdarmkanaalbloeding
French Saignement GI supérieur, Perte sanguine des voies GI supérieures, Hémorragie gastrointestinale haute, Saignement gastro-intestinal haut, Hémorragie gastro-intestinale haute
German Blutverlust im oberen gastrointestinalen Bereich, UGI-Blutung, Bluten im oberen Gastrointestinaltrakt, Blutung im oberen gastrointestinalen Bereich
Portuguese Hemorragia gastrintestinal alta, Perda de sangue GI alta, Sangramento gastrointestinal superior, Hemorragia gastrointestinal superior
Spanish Pérdida de sangre GI superior, Sangrado GIA, Hemorragia gastrointestinal superior, Sangrado del tracto GI superior, HDA, hemorragia GI superior, hemorragia digestiva alta (trastorno), hemorragia digestiva alta, hemorragia gastrointestinal alta, hemorragia gastrointestinal superior, sangrado GI superior, sangrado gastrointestinal superior, Hemorragia gastrointestinal alta
Japanese 上部消化管出血, ｼﾞｮｳﾌﾞｼｮｳｶｶﾝｼｭｯｹﾂ
Czech Krvácení do horní části zažívacího traktu, Krvácení v horní části zažívacího traktu, Krvácení z horní části zažívacího traktu
Hungarian Gyomor-bélrendszer felső traktusának vérzése, Felső gastrointestinalis vérvesztés, Felső gastrointestinalis vérzés, Felső gasztrointesztinalis vérzés
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Esophagogastroduodenoscopy (C0079304)

Definition (NCI) An endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum.
Concepts Diagnostic Procedure (T060)
MSH D016145
SnomedCT 387596007, 76009000, 29167001, 386830000, 142500004, 173826001
CPT 1021431
LNC LP6240-8
English Esophagogastroduodenoscopies, Esophagogastroduodenoscopy, Combined upper GI endoscopy, Endoscopic exam oeso,stom,duod, Endoscopic exam upper GI tract, Endoscopic examination of esophagus, stomach and duodenum, Endoscopic examination of oesophagus, stomach and duodenum, Endoscopic examination of upper GI tract, Fibopt oesophagogastroduodenos, OGD - Esophagogastroduodenoscopy, OGD - Oesophagogastroduodenosc, OGD - Oesophagogastroduodenoscopy, Fibreoptic oesophagogastroduodenoscopy (procedure), Fiberoptic esophagogastroduodenoscopy (procedure), upper digestive system endoscopy, Endoscopy upper gastrointestinal tract, Upper gastrointestinal tract endoscopy, EGD, egd, endoscopy gi upper, upper gastrointestinal endoscopy, egds, endoscopy upper gi, oesophagogastroduodenoscopy, upper gi endoscopy, Upper GI endoscopy, Endoscopic examination of esophagus, stomach and duodenum (procedure), Oesophagogastroduodenoscopy (procedure), Upper Gastrointestinal endoscopy, Esophagogastroduodenoscopy Procedures, esophagogastroduodenoscopy, diagnostic esophagogastroduodenoscopy (procedure), diagnostic esophagogastroduodenoscopy, esophagogastroduodenoscopy (treatment), Fiberoptic esophagogastroduodenoscopy, Fibreoptic oesophagogastroduodenoscopy, Oesophagogastroduodenoscopy, Upper gastrointestinal endoscopy, Esophagogastroduodenoscopy (procedure)
Italian Endoscopia del tratto gastrointestinale superiore, Esafago-gastro-duodenoscopia, EGD, Esofagogastroduodenoscopia
Dutch bovenste maagdarmstelsel endoscopie, endoscopie bovenste maagdarmstelsel, oesophagogastroduodenoscopie, Oesofagogastroduodenoscopie
Portuguese Endoscopia gastrintestinal alta, Esofagogastroduodenoscopia, Endoscopia gastrointestinal alta
Spanish Endoscopia del tracto gastrointestinal alto, Esofagogastroduodenoscopía, examen endoscópico de esófago, estómago y duodeno, examen endoscópico de esófago, estómago y duodeno (procedimiento), endoscopia del tracto gastrointestinal superior, esofagogastroduodenoscopia (procedimiento), esofagogastroduodenoscopia de fibra óptica (procedimiento), esofagogastroduodenoscopia de fibra óptica, esofagogastroduodenoscopia, Endoscopia del tracto gastrointestinal superior, Esofagogastroduodenoscopia
Japanese 食道胃十二指腸内視鏡検査, 上部消化管内視鏡検査, ｼｮｸﾄﾞｳｲｼﾞｭｳﾆｼﾁｮｳﾅｲｼｷｮｳｹﾝｻ, ｼﾞｮｳﾌﾞｼｮｳｶｶﾝﾅｲｼｷｮｳｹﾝｻ
German Ösophagogastroduodenoskopie, Oesophagogastroduodenoskopie, Endoskopie des oberen Gastrointestinaltrakts
Czech Ezofagogastroduodenoskopie, Endoskopie horního gastrointestinálního traktu
French Oesophago-gastro-duodénoscopie, Oesophagogastroduodénoscopie, Endoscopie du tractus gastro-intestinal supérieur, Fibroscopie oesophago-gastro-duodénale
Hungarian Felső gasztrointesztinális endoszkópia, Oesophagogastroduodenoscopia, Felső gasztrointesztinális rendszer endoscopia
Norwegian Øsofagogastroduodenoskopi
Derived from the NIH UMLS (Unified Medical Language System)

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