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Upper Gastrointestinal Haemorrhage

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Acute Care Surgery Handbook

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Abstract

Upper gastrointestinal haemorrhage remains a frequent cause of hospital admission and morbidity. Presentation varies from mild cases to patients with exsanguinating haemorrhage requiring resuscitation and emergency intervention. The majority of cases are due to peptic ulceration and respond to medical care and endoscopic techniques. Less common causes usually require the same initial management although definitive treatment will be different. Bleeding oesophageal varices are the exception and require a different strategy from the outset. Severe life-threatening haemorrhage or persistent and recurrent bleeding following endoscopic therapy will require interventional radiology or emergency surgery. The operative procedure will depend on the cause of the haemorrhage but ranges from simple oversewing of a bleeding point to emergency gastrectomy. These cases can be a significant challenge for the emergency surgeon as often these patients are old with significant co-morbidities. There is no role for acid-reducing operations such as vagotomy and antrectomy although resective operations may still be required for large and difficult ulcers where a more extensive operation is needed to safely deal with the pathology.

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References

  1. Jairath V, Desborough MJ. Modern-day management of upper gastrointestinal haemorrhage. Transfus Med. 2015;25(6):351–7.

    Article  CAS  PubMed  Google Scholar 

  2. Laursen SB. Treatment and prognosis in peptic ulcer bleeding. Dan Med J. 2014;61(1):B4797.

    Google Scholar 

  3. Crooks C, Card T, West J. Reductions in 28-d mortality following hospital admission for upper gastrointestinal hemorrhage. Gastroenterology. 2011;141:62–70.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Grainek IM, Dumonceau J-M, Kuipers EJ, et al. Diagnosis and Management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guidleine. Endoscopy. 2015;47:a1–46.

    Article  Google Scholar 

  5. Barkun A, Bardou M, Marshall JK. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003;139:843–57.

    Article  PubMed  Google Scholar 

  6. Vergara M, Bennett C, Calvet X, Gisbert JP. Epinephrine injection versus epinephrine injection and a second endoscopic method in high-risk bleeding ulcers. Cochrane Database Syst Rev. 2014;(10):CD005584.

    Google Scholar 

  7. deGroot NI, van Oijen MG, Kessels K, et al. Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified? Endoscopy. 2014;46:46–52.

    Article  Google Scholar 

  8. Bacarat F, Moura E, Bernardo W, et al. Endoscopic hemostasis for peptic ulcer bleeding: systematic review and meta-analyses of randomized controlled trials. Surg Endosc. 2015;1–14.

    Google Scholar 

  9. Jacques J, Legros R, Chaussade S, Sautereau D. Endoscopic haemostasis: an overview of procedures and clinical scenarios. Dig Liver Dis. 2014;46(9):766–76.

    Article  PubMed  Google Scholar 

  10. Di Saverio S, et al. Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg. 2014;9:45.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Holster IL, Kuipers EJ. Management of acute nonvariceal upper gastrointestinal bleeding: current policies and future perspectives. World J Gastroenterol. 2012;18:1202–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gregory Walker T, Salazar GM, Waltman AC. Angiographic evaluation and management of acute gastrointestinal hemorrhage. World J Gastroenterol. 2012;1191–1201.

    Google Scholar 

  13. Elmunzer BJ, Young SD, Inadomi JM, Schoenfeld P, Laine L. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008;103(10):2625–32.

    Article  PubMed  Google Scholar 

  14. Imhof M, Ohmann C, Röher HD, Glutig H. DUESUC study group. Endoscopic versus operative treatment in high-risk ulcer bleeding patients – results of a randomised study. Langenbecks Arch Surg. 2003;387:327–36.

    PubMed  Google Scholar 

  15. Abe N, Takeuchi H, Yanagida O, Sugiyama M, Atomi Y. Surgical indications and procedures for bleeding peptic ulcer. Dig Endosc. 2010;22 Suppl 1:S35–7.

    Article  PubMed  Google Scholar 

  16. Lau JY, Sung JJ, Lam YH, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med. 1999;340:751–6.

    Article  CAS  PubMed  Google Scholar 

  17. Laursen SB, Jakobsen M, Nielsen MM, Hovendal C, Schaffalitzky de Muckadell OB. Transcatheter arterial embolization is the first-line therapy of choice in peptic ulcer bleeding not responding to endoscopic therapy. Scand J Gastroenterol. 2015;50(3):264–71.

    Article  CAS  PubMed  Google Scholar 

  18. Schroder VT, Pappas TN, Vaslef SN, De La Fuente SG, Scarborough JE. Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers. Ann Surg. 2014;259(6):1111–8.

    Article  PubMed  Google Scholar 

  19. Sverdén E, Sondén A, Leinsköld T, Lagergren J, Lu Y. Minimal versus definitive surgery in managing peptic ulcer bleeding: a population-based cohort study. Dig Surg. 2014;31(4–5):276–82.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  Google Scholar 

  21. Poxon VA, Keighley MR, Dykes PW, Heppinstall K, Jaderberg M. Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial. Br J Surg. 1991;78(11):1344–5.

    Article  CAS  PubMed  Google Scholar 

  22. So JB, Yam A, Cheah WK, Kum CK, Goh PM. Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy. Br J Surg. 2000;87(12):1702–7.

    Article  CAS  PubMed  Google Scholar 

  23. Chereau N, Chandeze M-M, Tantardini C, et al. Antroduodenectomy with gastroduodenal anastomosis: salvage emergency surgery for complicated peptic ulcer disease-results of a double institution study of 35 patients. J Gastrointest Surg. 2016;20(3):539–45.

    Article  PubMed  Google Scholar 

  24. Tripathi D, Stanley AJ, Hayes PC, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015;64(11):1680–704.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kumbhari V, Saxena P, Khashab MA. Self-expandable metallic stents for bleeding esophageal varices. Saudi J Gastroenterol. 2013;19(4):141–3.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lonn L, Dias N, Veith Schroeder T, Resch T. Is EVAR the treatment of choice for aortoenteric fistula? J Cardiovasc Surg (Torino). 2010;51(3):319–27.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Acute Surgery Unit, Canberra Hospital, Garran, ACT, Australia

    Michael D. Kelly

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  1. Michael D. Kelly
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Correspondence to Michael D. Kelly .

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Editors and Affiliations

  1. Emergency and Trauma Surgery Service, C.A. Pizzardi Maggiore Hospital AUSL Bologna, Bologna, Italy

    Salomone Di Saverio

  2. Surgery and Emergency, Maggiore Hospital of Parma, Parma, Italy

    Fausto Catena

  3. General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Luca Ansaloni

  4. General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Federico Coccolini

  5. Trauma, Emergency Medicine, Harvard Medical School Massachusetts General Hospital, Boston, Massachusetts, USA

    George Velmahos

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Kelly, M.D. (2016). Upper Gastrointestinal Haemorrhage. In: Di Saverio, S., Catena, F., Ansaloni, L., Coccolini, F., Velmahos, G. (eds) Acute Care Surgery Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-15362-9_7

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  • DOI: https://doi.org/10.1007/978-3-319-15362-9_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15361-2

  • Online ISBN: 978-3-319-15362-9

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