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Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding
Mitsuhiro Fujishiro1, Mikitaka Iguchi1, Naomi Kakushima1
1Japan Gastroenterological Endoscopy Society, Tokyo, Japan.
Insights
The Japan Gastroenterological Endoscopy Society (JGES) provides evidence-based guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding, primarily peptic ulcers. Endoscopic hemostasis is the first-line treatment, with antisecretory agents recommended to prevent rebleeding.
Area of Science:
- Gastroenterology
- Endoscopic procedures
- Evidence-based medicine
Background:
- Non-variceal upper gastrointestinal bleeding, predominantly from peptic gastroduodenal ulcers, is a significant clinical concern.
- Epidemiological trends in Japan show an increase in drug-related ulcer bleeding compared to Helicobacter pylori (HP)-related ulcers.
- Aging population and HP eradication therapy coverage influence ulcer bleeding causes.
Purpose of the Study:
- To establish evidence-based guidelines for the endoscopic management of non-variceal upper gastrointestinal bleeding.
- To focus primarily on peptic gastroduodenal ulcer bleeding while also addressing other causes.
- To provide recommendations for treatment and prevention of rebleeding.
Main Methods:
- Compilation of guidelines by the Japan Gastroenterological Endoscopy Society (JGES) using evidence-based methods.
- Review of clinical research studies to formulate evidence and recommendation levels for treatment statements.
- Focus on endoscopic hemostasis as the primary treatment modality.
Main Results:
- Endoscopic hemostasis is recommended as the first-line treatment for most causes of non-variceal upper gastrointestinal bleeding.
- Intensive patient evaluation and stabilization are crucial for successful endoscopic hemostasis.
- Antisecretory agents are recommended for preventing rebleeding after endoscopic hemostasis, particularly for gastroduodenal ulcers.
- Eighteen statements with evidence and recommendation levels were developed by the JGES committee.
Conclusions:
- The guidelines provide a framework for managing non-variceal upper gastrointestinal bleeding based on current evidence.
- Further clinical research is needed to confirm statements supported by a low level of evidence.
- Effective endoscopic hemostasis requires careful patient assessment and management.
Abstract:
Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.
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