Upper Endoscopy Evaluation of GI Bleeding

1. See Also
   1. Upper GI Bleeding
2. Indications
   1. Risk used to determine disposition in Upper GI Bleed
3. 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
4. Techniques: Measures used to coagulate bleeding sites
   1. Efficacy
      1. All methods appear to be equally efficacious
      2. Many endoscopists both inject and coagulate lesions
   2. Thermal Contact
      1. Heater probe
      2. Multipolar electrocoagulation
   3. Bleeding site injection
      1. Epinephrine injection
      2. Alcohol injection (sclerosing agent)
         1. Higher risk of perforation
   4. Laser (rarely used)
      1. Nd:YAG Laser
      2. Argon Laser
5. 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
6. 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
7. Interpretation: High risk findings
   1. Actively bleeding ulcer or other bleeding lesion
   2. Vessel visible on endoscopy
   3. Esophageal Varices with active bleeding
8. Management: Post-procedure
   1. Rebleeding occurs in 20% of cases despite treatment
   2. Second-look endoscopy in 24 hours may be recommended
9. References
   1. Terdiman (1998) Postgrad Med 103(6):43-64
   2. Fallah (2000) Med Clin North Am 84(5):1183-208