Gastrointestinal Hemorrhage

• Acute Upper GI Bleed
• Acute Lower GI Bleed

Acute Upper GI Bleed

The fellow should be able to:

• Demonstrate an understanding of the causes of upper GI hemorrhage including the difference between variceal and non-variceal bleeding
• Demonstrate an understanding of medical management in upper GI bleeding
• Demonstrate an understanding of the evaluation in the acute upper GI bleed including the role of endoscopy and imaging
• Discuss the imaging options to diagnose upper GI bleeding and limitations of each
• Describe the endoscopic classification for UGI bleeding related to ulcer disease
• Describe the treatment options for UGI bleeding including indications for endoscopy, IR, and surgery
• Describe the surgical technique for UGI bleeding from a gastric source
• Describe the surgical technique for UGI bleeding from a duodenal source

Resources

• Topic Summary
• AAST Education Module - Gastrointestinal Bleeding
• AAST Education Module - Gastroesophageal Varices
• Meet the Mentors - Advanced Endoscopy for the Acute Care Surgeon
• Overview Articles:
  • Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917.
  • Hernández-Gea V, Berbel C, Baiges A, García-Pagán JC. Acute variceal bleeding: risk stratification and management (including TIPS). Hepatol Int. 2018;12(Suppl 1):81-90.
• Additional Resources:
  • International Consensus Guidelines on management of UGIB - Barkun AN, Almadi M, Kuipers EJ, et Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171(11):805-822.
  • Embolization vs surgery for recurrent UGIB- Tarasconi A, Baiocchi GL, Pattonieri V, et al. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis. World J Emerg Surg. 2019;14:3.
  • Embolization vs surgery for uncontrolled UGIB - Sverdén E, Mattsson F, Lindström D, Sondén A, Lu Y, Lagergren J. Transcatheter Arterial Embolization Compared With Surgery for Uncontrolled Peptic Ulcer Bleeding: A Population-based Cohort Study. Ann Surg. 2019;269(2):304-309
  • Annals of Internal Medicine lower and upper GIB summary- Tokar JL, Higa JT. Acute Gastrointestinal Bleeding. Ann Intern Med. 2022;175(2):ITC17-ITC32.
  • Vasopressors for AVB - Huaringa-Marcelo J, Huaman MR, Brañez-Condorena A, et al. Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis. J Gastrointestin Liver Dis. 2021;30(1):110-121.
  • Complications in cirrhosis - Premkumar M, Anand AC. Overview of Complications in Cirrhosis. J Clin Exp Hepatol. 2022;12(4):1150-1174.

Return to top.

Acute Lower GI Bleed

The fellow should be able to:

• Demonstrate an understanding of the causes of lower GI hemorrhage
• Demonstrate an understanding of medical management in lower GI bleeding
• Demonstrate an understanding of the evaluation of a lower GI bleed including the role of endoscopy and imaging
• Discuss the imaging options to diagnose lower GI bleeding and limitations of each
• Describe the treatment options for lower UGI bleeding including indications for endoscopy, IR, and surgery
• Describe the diagnostic and surgical technique for lower UGI bleeding from an unclear source

Resources

• Topic Summary
• Meet the Mentors - Lower GI Bleeding for (Puzzled) Surgeons
• Overview Article:
  • Sengupta N, Feuerstein JD, Jairath V, Shergill AK, Strate LL, Wong RJ, Wan D. Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. Am J Gastroenterol. 2023;118(2):208-231.
• Additional Resources:
  • Colonoscopy vs angioembolization in LGIB- Miyakuni Y, Nakajima M, Ohbe H, et al. Angiography versus colonoscopy in patients with severe lower gastrointestinal bleeding: a nation-wide observational study. Acute Med Surg. 2020;7(1):e533.
  • Provocative angiography in LGIB- Smith SCL, Bazarova A, Ejenavi E, et al. A multicentre development and validation study of a novel lower gastrointestinal bleeding score-The Birmingham Score. Int J Colorectal Dis. 2020;35(2):285-293.
  • Annals of Internal Medicine lower and upper GIB summary- Tokar JL, Higa JT. Acute Gastrointestinal Bleeding. Ann Intern Med. 2022;175(2):ITC17-ITC32.

Return to Top.