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Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
[Update on non-variceal gastrointestinal bleeding]
1Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, IIS Aragón, CIBERehd, Zaragoza, España.
Insights
Early endoscopy and proton pump inhibitors (PPIs) do not improve outcomes for gastrointestinal bleeding. Oral PPIs are as effective as IV PPIs post-hemostasis, and NSAID risks require careful consideration.
Area of Science:
- Gastroenterology
- Clinical Medicine
Context:
- Review of key studies presented at the 2013 American Congress of Gastroenterology (Digestive Disease Week).
- Focus on non-variceal gastrointestinal bleeding, addressing areas of clinical uncertainty.
Purpose:
- To summarize recent advancements and findings in non-variceal gastrointestinal bleeding.
- To highlight new knowledge regarding diagnostic and therapeutic strategies.
Summary:
- Early endoscopy (within 6 hours for UGIB, 24 hours for LGIB) and pre-endoscopic proton pump inhibitor (PPI) administration do not improve patient prognosis.
- Oral PPIs demonstrate comparable efficacy to intravenous PPIs following endoscopic hemostasis in upper gastrointestinal bleeding (UGIB).
- Radiofrequency ablation shows promise for treating antral vascular ectasia.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and coxibs necessitate careful risk assessment (gastrointestinal and cardiovascular), especially when co-prescribed with other gastrotoxic agents.
- Environmental and genetic factors contribute to individual susceptibility to gastrointestinal bleeding.
Impact:
- Challenges current practices regarding early endoscopy and PPI use in gastrointestinal bleeding.
- Suggests a shift towards oral PPIs for post-hemostasis management.
- Emphasizes personalized risk assessment for NSAID/coxib prescribing.
- Highlights the multifactorial nature of gastrointestinal bleeding susceptibility.
Abstract:
This article summarizes the main studies in the field of non-variceal gastrointestinal bleeding reported in the last American Congress of Gastroenterology (Digestive Disease Week) in 2013. Some of these studies have provided new knowledge and expertise in areas of uncertainty. In this context and among other findings, it has been reported that the administration of a proton pump inhibitor (PPI) prior to endoscopy or the early performance of endoscopy-within 6 hours of admission in patients with upper gastrointestinal bleeding (UGIB) (or colonoscopy within 24 hours in patients with lower gastrointestinal bleeding)-does not improve the prognosis of the event. It has also been reported that oral administration of a PPI after endoscopic hemostasis may produce a similar outcome to that of intravenously administered PPI in patients with upper gastrointestinal bleeding (UGIB). In the field of endoscopic therapy, the use of radiofrequency ablation for antral vascular ectasia is of interest. Regarding UGIB and nonsteroidal antiinflammatory drugs (NSAIDs), new data confirm the risk of cardiovascular events by stopping treatment with acetylsalicylic acid (ASA) after an episode of UGIB, the increased risk of UGIB when associating gastrotoxic drugs, and the need to identify both the gastrointestinal and cardiovascular risks of each NSAID and coxib when prescribing these agents. Finally, there is evidence that both environmental and genetic factors are involved in individual susceptibility to gastrointestinal bleeding.
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