How many times is endoscopic intervention necessary for upper GI bleed?

From the Guidelines

Endoscopic intervention is typically necessary once for most upper gastrointestinal (GI) bleeds, with approximately 10-20% of patients requiring a second intervention due to rebleeding. The initial endoscopy serves both diagnostic and therapeutic purposes, allowing for direct visualization of the bleeding source and immediate treatment. Common endoscopic treatments include injection therapy with epinephrine, thermal coagulation, mechanical clips, or a combination of these methods. For high-risk lesions (such as actively bleeding ulcers or visible vessels), endoscopic therapy reduces rebleeding rates, need for surgery, and mortality 1. If rebleeding occurs, a second endoscopic attempt is usually recommended before considering more invasive options like interventional radiology or surgery. Patients with severe bleeding, hemodynamic instability, or those who fail endoscopic management may require additional interventions. The timing of endoscopy is also important, with early endoscopy (within 24 hours) recommended for most upper GI bleeds, and very early endoscopy (within 12 hours) for patients with high-risk features such as hemodynamic instability or signs of ongoing bleeding.

Some key points to consider:

• Early endoscopy (within 24 hours) is recommended for most patients with acute upper gastrointestinal bleeding 1.
• Endoscopic hemostasis is reserved for patients with high-risk endoscopic lesions, and combination therapy with injection and thermal coagulation is superior to monotherapy 1.
• Routine second-look endoscopy is not recommended, but repeat endoscopy may be considered in cases of rebleeding or suboptimal initial endoscopic therapy 1.
• Patients with upper gastrointestinal bleeding should be tested for Helicobacter pylori infection and receive eradication therapy if infection is present 1.

Overall, the goal of endoscopic intervention is to reduce morbidity, mortality, and improve quality of life for patients with upper GI bleeds. By following current guidelines and recommendations, clinicians can provide effective and timely treatment for these patients.

From the Research

Endoscopic Intervention for Upper GI Bleed

• The frequency of endoscopic intervention necessary for upper GI bleed is not explicitly stated in the provided studies, but the timing and outcomes of endoscopy are discussed 2, 3, 4, 5, 6.
• According to a study published in 2022, endoscopy within 24 hours of presentation is recommended for patients with acute upper gastrointestinal bleeding, with early endoscopy (within 6-24 hours) associated with superior outcomes compared to urgent (within 6 hours) or late (within 24-48 hours) endoscopy 6.
• Another study from 2020 suggests that patients with hemodynamic instability and signs of upper GI bleeding should be offered urgent endoscopy, performed within 24 hours of presentation 3.
• The management of severe upper gastrointestinal bleeding in the ICU involves prompt recognition and resuscitation, careful use of blood products, early correction of coagulopathy, and early endoscopic or radiologic interventions 4.
• A study from 2019 recommends that endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability 5.
• The optimal timing of endoscopy for acute upper gastrointestinal bleeding is still uncertain, but the available evidence suggests that early endoscopy (within 24 hours) is associated with better outcomes compared to urgent or late endoscopy 2, 6.
• Recurrent bleeding may require repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery 5.