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Upper Gastrointestinal Bleeding

  • Marcel Tafen
  • Steven C. Stain
Chapter

Abstract

Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that accounts for a significant number of hospitalizations, leading to considerable morbidity, mortality, and resource utilization. UGIB has a multitude of causes, with peptic ulcer disease and varices being the most common, and disproportionately affects the elderly with a higher mortality among these patients. The majority of UGIB patients do not require intervention; therefore, identifying patients at risk of rebleeding or mortality is the goal. Aggressive resuscitation and timely endoscopy for localization of the bleeding source are paramount to identify patients who do not stop bleeding and may require endoscopic, surgical, or angiographic intervention.

Keywords

Upper gastrointestinal hemorrhage Varices Embolization Ulcer disease Angiography Endoscopic hemostasis Gastric ulcer Duodenal ulcer Dieulafoy’s lesion 

References

  1. 1.
    Zhao Y, Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006: statistical brief #65. Healthcare Cost and Utilization Project (HCUP) statistical briefs [Internet]. Rockville: Agency for Healthcare Research and Quality (US); 2006-2008.Google Scholar
  2. 2.
    Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J. The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data. Gastrointest Endosc. 1981;27(2):73–9. No abstract available.PubMedCrossRefGoogle Scholar
  3. 3.
    Abougergi MS, Travis AC, Saltzman JR. Impact of day of admission on mortality and other outcomes in upper GI hemorrhage: a nationwide analysis. Gastrointest Endosc. 2014;80(2):228–35.PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenstock SJ, Moller MH, Larsson H, Johnsen SP, Madsen AH, Bendix J, et al. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol. 2013;108(9):1449–57.PubMedCrossRefGoogle Scholar
  5. 5.
    Loffroy R, Estivalet L, Cherblanc V, Sottier D, Guiu B, Cercueil JP, et al. Transcatheter embolization as the new reference standard for endoscopically unmanageable upper gastrointestinal bleeding. World J Gastrointest Surg. 2012;4(10):223–7.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc. 2015;81(4):882–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90(2):206–10.PubMedGoogle Scholar
  8. 8.
    Sreedharan A, Martin J, Leontiadis G, Doward S, Howden CW, Forman D, et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;7:CD005415.Google Scholar
  9. 9.
    Al-Sabah S, Barkun AN, Herba K, Adam V, Fallone C, Mayrand S, et al. Cost-effectiveness of Proton-pump inhibition before endoscopt in upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2008;6(4):418–25.PubMedCrossRefGoogle Scholar
  10. 10.
    Cheng HC, Wu CT, Chang WL, Cheng WC, Chen WY, Sheu BS. Double oral esomeprazole after a 3-day intravenous esomeprazole infusion reduces recurrent peptic ulcer bleeding in high-risk patients: a randomised controlled study. Gut. 2014;63(12):1864–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Morrison CA, Carrick MM, Norman MA, Scott BG, Welsh FJ, Tsai P, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma. 2011;70(3):652–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345–60; quiz 361.PubMedCrossRefGoogle Scholar
  13. 13.
    Baradarian R, Ramdhaney S, Chapalamadugu R, Skoczylas L, Wang K, Rivilis S, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. J Gastroenterol. 2004;99(4):619–22.Google Scholar
  14. 14.
    Siegal DM, Konkle BA. What is the effect of rivaroxaban on routine coagulation tests? Hematology Am Soc Hematol Educ Program. 2014;2014(1):334–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Blasi A, Beltran J, Pereira A, Martinez-Palli G, Torrents A, Balust J, et al. An assessment of thromboelastometry to monitor blood coagulation and guide transfusion support in liver transplantation. Transfusion. 2012;52(9):1989–98.PubMedCrossRefGoogle Scholar
  16. 16.
    Black DAK, Powell JF. Absorption of haemoglobin iron. Biochem J. 1942;36(1-2):110–2.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Ernst AA, Haynes ML, Nick TG, Weiss SJ. Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding. Am J Emerg Med. 1999;17(1):70–2.PubMedCrossRefGoogle Scholar
  18. 18.
    Richards RJ, Donica MB, Grayer D. Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding? J Clin Gastroenterol. 1990;12(5):500–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Witting MD, Magder L, Heins AE, Mattu A, Granja CA, Baumgarten M. ED predictors of upper gastrointestinal tract bleeding in patients without hematemesis. Am J Emerg Med. 2006;24(3):280–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Jairath V, Kahan BC, Stanworth SJ, Logan RF, Hearnshaw SA, Travis SP, Palmer KR, Murphy MF. Prevalence, management, and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom Transfusion. 2013;53(5):1069–76. doi:  https://doi.org/10.1111/j.1537-2995.2012.03849.x. Epub 2012 Aug 15.PubMedCrossRefGoogle Scholar
  21. 21.
    Razzaghi A, Barkun AN. Platelet transfusion threshold in patients with upper gastrointestinal bleeding: a systematic review. J Clin Gastroenterol. 2012;46(6):482–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Hickey M, Gatien M, Taljaard M, Aujnarain A, Giulivi A, Perry JJ. Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department. Circulation. 2013;128(4):360–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Refaai MA, Goldstein JN, Lee ML, Durn BL, Milling TJ Jr, Sarode R. Increased risk of volume overload with plasma compared with four-factor prothrombin complex concentrate for urgent vitamin K antagonist reversal. Transfusion. 2015;55(11):2722–9.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Fawole A, Daw HA, Crowther MA. Practical management of bleeding due to anticoagulants dabigatran, rivaroxaban, and apixaban. Cleve Clin J Med. 2013;80(7):443–51.PubMedCrossRefGoogle Scholar
  25. 25.
    Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1–46.PubMedCrossRefGoogle Scholar
  26. 26.
    Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit. Gut. 2010;59(8):1022–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Bethea ED, Travis AC, Saltzman JR. Initial assessment and management of patients with nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48(10):823–9.PubMedGoogle Scholar
  28. 28.
    Wysocki JD, Srivastav S, Winstead NS. A nationwide analysis of risk factors for mortality and time to endoscopy in upper gastrointestinal haemorrhage. Aliment Pharmacol Ther. 2012;36:30–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Tsoi KKF, Ma TKW, Sung JJY. Endoscopy for upper gastrointestinal bleeding: how urgent is it? Nat Rev Gastroenterol Hepatol. 2009;6:463–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Park SJ, Park H, Lee YC, Choi CH, Jeon TJ, Park JC, et al. Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial. Gastrointest Endosc. 2017. pii: S0016-5107(17)32117-X. doi:  https://doi.org/10.1016/j.gie.2017.07.024. [Epub ahead of print].PubMedCrossRefGoogle Scholar
  31. 31.
    Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995;311:222–6.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Vreeburg EM, Snel P, de Bruijne JW, Bartelsman JF, Rauws EA, Tytgat GN. Acute upper gastrointestinal bleeding in the Amsterdam area: incidence, diagnosis, and clinical outcome. Am J Gastroenterol. 1997;92:236–43.PubMedGoogle Scholar
  33. 33.
    Enestvedt BK, Graknek IM, Mattek N, Lieberman DA, Eisen G. An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium. Gastrointest Endosc. 2008;67(3):422–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48(2):113–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Freeman ML. Stigmata of hemorrhage in bleeding ulcers. Gastrointest Endosc Clin N Am. 1997;7(4):559–74.PubMedCrossRefGoogle Scholar
  36. 36.
    Laine L, Peterson WL. Bleeding peptic ulcer. N Engl J Med. 1994;331(11):717–27.PubMedCrossRefGoogle Scholar
  37. 37.
    Wara P. Endoscopic prediction of major rebleeding—a prospective study of stigmata of hemorrhage in bleeding ulcer. Gastroenterology. 1985;88(5 Pt 1):1209–14.PubMedCrossRefGoogle Scholar
  38. 38.
    Mendelson AH, Donowitz M. Catching the zebra: clinical pearls and pitfalls for the successful diagnosis of Zollinger-Ellison syndrome. Dig Dis Sci. 2017;62(9):2258–65.  https://doi.org/10.1007/s10620-017-4695-7. Epub 2017 Aug 3.PubMedCrossRefGoogle Scholar
  39. 39.
    Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877):394–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Bratanic A, Puljiz Z, Ljubicicz N, Caric T, Jelicic I, Pulkiz M, et al. Predictive factors of rebleeding and mortality following endoscopic hemostasis in bleeding peptic ulcers. Hepatogastroenterology. 2013;60:112–7.PubMedGoogle Scholar
  41. 41.
    Sánchez-Delgado J, Gené E, Suárez D, et al. Has H. pylori prevalence in bleeding peptic ulcer been underestimated? A meta-regression. Am J Gastroenterol. 2011;106:398–405.PubMedCrossRefGoogle Scholar
  42. 42.
    Barkun AN, Moosavi S, Martel M. Topical hemostatic agents: a systematic review with particular emphasis on endoscopic application in GI bleeding. Gastrointest Endosc. 2013;77:692–700.PubMedCrossRefGoogle Scholar
  43. 43.
    Prachayakul V, Aswakul P, Chantarojanasiri T, Leelakusolvong S. Factors influencing clinical outcomes of Histoacryl® glue injection-treated gastric variceal hemorrhage. World J Gastroenterol. 2013;19(15):2379–87.  https://doi.org/10.3748/wjg.v19.i15.2379. Published online 2013 Apr 21.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Lee YJ, Min BR, Kim ES, Park KS, Cho KB, Jang BK, et al. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding. Korean J Intern Med. 2016;31(1):54–64.  https://doi.org/10.3904/kjim.2016.31.1.54. Published online 2015 Dec 28.PubMedCrossRefGoogle Scholar
  45. 45.
    Napolitano L. Refractory peptic ulcer disease. Gastroenterol Clin North Am. 2009;38(2):267–88.PubMedCrossRefGoogle Scholar
  46. 46.
    Lee CW, Sarosi GA Jr. Emergency ulcer surgery. Surg Clin North Am. 2011;91(5):1001–13.PubMedCrossRefGoogle Scholar
  47. 47.
    Brown DP. Gastric packing in the control of massive gastroduodenal hemorrhage. Am J Gastroenterol. 1970;54(1):49–51.PubMedGoogle Scholar
  48. 48.
    Cortese F, Colozzi S, Marcello R, Muttillo IA, Giacovazzo F, Nardi M, et al. Gastroduodenal major haemorrhages in critical patients: an original surgical technique. Am Ital Chir. 2013;84(6):671–9.Google Scholar
  49. 49.
    White RI Jr, Harrington DP, Novak G, Miller FJ Jr, Giargiana FA Jr, Sheff RN. Pharmacologic control of hemorrhagic gastritis: clinical and experimental results. Radiology. 1974;111(3):549–57.PubMedCrossRefGoogle Scholar
  50. 50.
    Millat B, Hay JM, Valleur P, et al. Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research. World J Surg. 1993;17(5):568–73. discussion 574.PubMedCrossRefGoogle Scholar
  51. 51.
    Sugawa C, Steffes CP, Nakamura R, Sferra JJ, Sferra CS, Sugimura Y, et al. Upper GI bleeding in an urban hospital. Etiology, recurrence, and prognosis. Ann Surg. 1990;212(4):521–6; discussion 526-7.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Zimmerman J, Shohat V, Tsvang E, Arnon R, Safadi R, Wengrower D. Esophagitis is a major cause of upper gastrointestinal hemorrhage in the elderly. Scand J Gastroenterol. 1997;32(9):906–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Owen DA. Gastritis and carditis. Mod Pathol. 2003;16(4):325–41.PubMedCrossRefGoogle Scholar
  54. 54.
    Czaja AJ, McAlhany JC, Pruitt BA Jr. Acute gastroduodenal disease after thermal injury. An endoscopic evaluation of incidence and natural history. N Engl J Med. 1974;291(18):925–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Martin LF. Gastrointestinal bleeding in critically ill patients. N Engl J Med. 1994;331(1):51–2; author reply 52-3.PubMedCrossRefGoogle Scholar
  56. 56.
    Goldman MS Jr, Rasch JR, Wiltsie DS, Finkel M. The incidence of esophagitis in peptic ulcer disease. Am J Dig Dis. 1967;12(10):994–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Barletta JF, Mangram AJ, Sucher JF, Zach V. Stress ulcer prophylaxis in neurocritical care. Neurocrit Care. 2017;  https://doi.org/10.1007/s12028-017-0447-y. [Epub ahead of print].
  58. 58.
    Peura DA, Johnson LF. Cimetidine for prevention and treatment of gastroduidenalmuscosal lesions in patients in an intensive care unit. Ann Intern Med. 1985;103(2):173–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Schuster DP, Rowley H, Feinstein S, McGue MK, Zuckerman GR. Prospective evaluation of the risk of upper gastrointestinal bleeding after admissions to a medical intensive care unit. Am J Med. 1984;76(4):623–30.PubMedCrossRefGoogle Scholar
  60. 60.
    Zuckerman GR, Shuman R. Therapeutic goals and treatment options for prevention of stress ulcer syndrome. Am J Med. 1987;83(6A):29–35.PubMedCrossRefGoogle Scholar
  61. 61.
    Cook DJ, Reeve BK, Scholes LC. Histamine-2-receptor antagonists and antacids in the critically ill population: stress ulceration versus nosocomial pheumonia. Infect Control Hosp Epidemiol. 1994;15(7):437–42.PubMedCrossRefGoogle Scholar
  62. 62.
    Sugawa C, Benishek D, Walt AJ. Mallory-Weiss syndrome. A study of 224 patients. Am J Surg. 1983;145(1):30–3.PubMedCrossRefGoogle Scholar
  63. 63.
    Lee YT, Walmsley RS, Leong RW, Sung JJ. Dieulafoy’s lesion. GastrointestvEndosc. 2003;58(2):236–43.Google Scholar
  64. 64.
    Juler GL, Labitzke HG, Lamb R, Allen R. The pathogenesis of Dieulafoy’s gastric erosion. Am J Gastroenterol. 1984;79(3):195–200.PubMedGoogle Scholar
  65. 65.
    Norton ID, Petersen BT, Sorbi D, Balm RK, Alexander GL, Gostout CJ. Management and long-term prognosis of Dieulafoylesion. Gastrointest Endosc. 1999;50(6):762–7.PubMedCrossRefGoogle Scholar
  66. 66.
    Cathcart S, Birk JW, Tadros M, Schuster MJ. Hemobilia: an uncommon but notable cause of upper gastrointestinal bleeding. Clin Gastroenterol. 2017;51(9):796–804.Google Scholar
  67. 67.
    Camus M, Jensen DM, Ohning GV, Kovacs TO, Ghassemi KA, Jutabha R, et al. Severe upper gastrointentestinal hemorrhage from linear gastric ulcers in large hiatal hernias: a large prospective case series of Cameron ulcers. Endoscopy. 2013;45(5):397–400.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Gray DM, Kushnir V, Kalra G, Rosenstock A, Alsakka MA, Patel A, et al. Cameron lesions in patients with hiatal hernias: prevalence, presentation, and treatment outcome. Dis Esophagus. 2015;28(5):448–52.PubMedCrossRefGoogle Scholar
  69. 69.
    Berzigotti A, Bosch J, Boyer TD. Use of noninvasive markers of portal hypertension and timing of screening endoscopy for gastroesophageal varices in patients with chronic liver disease. Hepatology. 2014;59(2):729–31.PubMedCrossRefGoogle Scholar
  70. 70.
    Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266–72.PubMedCrossRefGoogle Scholar
  71. 71.
    Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Reverter E, Tandon P, Augustin S, Turon F, Casu S, Bastiampillai R, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology. 2014;146(2):412–9. e3.PubMedCrossRefGoogle Scholar
  73. 73.
    Stiegmann GV, Goff JS, Michaletz-Onody PA, Korula J, Lieberman D, Saeed ZA, et al. Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med. 1992;326(23):1527–32.PubMedCrossRefGoogle Scholar
  74. 74.
    Villanueva C, Piqueras M, Aracil C, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol. 2006;45:560–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Sengstaken RW, Blakemore AH. Balloon tamponage for the control of hemorrhage from esophageal varices. Ann Surg. 1950;131:781–9.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Wright G, Lewis H, Hogan B, et al. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc. 2010;71:71–8.PubMedCrossRefGoogle Scholar
  77. 77.
    D’Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995;22(1):332–54.PubMedGoogle Scholar
  78. 78.
    Yoshida H, Mamada Y, Taniai N, Yoshioka M, Hirakata A, Kawano Y, et al. Treatment modalities for bleeding esophagogastric varices. J Nippon Med Sch. 2012;79(1):19–30.PubMedCrossRefGoogle Scholar
  79. 79.
    Lin CT, Huang TW, Lee SC, et al. Sengstaken-Blakemore tube related esophageal rupture. Rev Esp Enferm Dig. 2010;102:395–6.PubMedGoogle Scholar
  80. 80.
    García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al.; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. Am Surg. 1990;56(12):758–63.Google Scholar
  81. 81.
    Evans GR1, Yellin AE, Weaver FA, Stain SC. Sinistral (left-sided) portal hypertension. N Engl J Med. 2010;362(25):2370–9.CrossRefGoogle Scholar
  82. 82.
    Grady E. Gastrointestinal bleeding scintigraphy in the early 21st century. J Nucl Med. 2016;57(2):252–9.  https://doi.org/10.2967/jnumed.115.157289. Epub 2015 Dec 17.PubMedCrossRefGoogle Scholar
  83. 83.
    Chua AE, Ridley LJ. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding. J Med Imaging Radiat Oncol. 2008;52(4):333–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Gaba RC. Transjugular intrahepatic portosystemic shunt creation with embolization or obliteration for variceal bleeding. Tech Vasc Interv Radiol. 2016;19(1):21–35.PubMedCrossRefGoogle Scholar
  85. 85.
    Barkun AN, Bardou M, Kuipers EJ, Sung J, Hunt RH, Martel M, et al.; International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13.Google Scholar
  86. 86.
    Abougergi MS, Avila P, Saltzman JR. Impact of insurance status and race on outcomes in nonvariceal upper gastrointestinal hemorrhage: a nationwide analysis. J Clin Gastroenterol. 2017;  https://doi.org/10.1097/MCG.0000000000000909. [Epub ahead of print].
  87. 87.
    Berne CJ, Tosoff L. Peptic ulcer perforation of the gastroduodenal artery complex: clinical features and operative control. Ann Surg. 1969;169(1):141–4.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Shin JH. Recent update of embolization of upper gastrointestinal tract bleeding. Korean J Radiol. 2012;13(Suppl1):S31–9.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryAlbany Medical CollegeAlbanyUSA

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