On-call treatment of acute gastrointestinal hemorrhage

Urgent treatment of gastrointestinal bleeding is multidisciplinary and often variable by institution. In general, medical management is the first-line therapy for both upper and lower gastrointestinal hemorrhage. In severe upper gastrointestinal hemorrhage, endoscopy is performed prior to other interventions as it is often both diagnostic and therapeutic. Embolization is performed for refractory arterial bleeding. Transjugular portosystemic shunt insertion may be performed to treat refractory variceal bleeding although its use at night is controversial. The treatment algorithm for lower gastrointestinal bleeding is less clear but in general, severe bleeding is handled in the interventional suite by superselective embolization and less severe bleeding is initially treated by endoscopy after an 8- to 12-hour bowel prep. This article will summarize the current approach in my hospital for treating patients with acute gastrointestinal hemorrhage.