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Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018
Joseph Jy Sung1, Philip Wy Chiu1, Francis K L Chan1
1Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
Insights
Updated guidelines address non-variceal upper gastrointestinal bleeding (NVUGIB) management. Key advancements include new endoscopic techniques and strategies for managing patients on antiplatelet or anticoagulant medications.
Area of Science:
- Gastroenterology
- Internal Medicine
- Emergency Medicine
Background:
- Non-variceal upper gastrointestinal bleeding (NVUGIB) is a critical emergency with high morbidity and mortality.
- Endoscopic therapy is the established 'gold standard' for managing NVUGIB.
- Significant advancements have occurred in NVUGIB management since the previous Asia-Pacific consensus.
Purpose of the Study:
- To provide updated, practical management guidelines for NVUGIB based on recent evidence.
- To address new challenges, including the use of dual antiplatelet agents and direct oral anticoagulants in NVUGIB patients.
Main Methods:
- Review of recent clinical evidence and advancements in NVUGIB management.
- Examination of pre-endoscopic, endoscopic, and post-endoscopic treatment strategies.
- Consideration of emerging techniques and challenges in patient populations with cardiac and cerebrovascular diseases.
Main Results:
- Incorporation of pre-endoscopy risk stratification, transfusion strategies, and proton pump inhibitors.
- Integration of novel endoscopic hemostasis techniques like hemostatic powder and over-the-scope clips.
- Recommendations for post-endoscopy management, including second-look endoscopy and medication strategies, alongside emerging techniques.
Conclusions:
- Updated guidelines offer practical approaches to NVUGIB management.
- Emphasizes the need for clear guidelines on managing antiplatelet and anticoagulant agents in NVUGIB patients.
- Highlights the importance of adapting to new endoscopic technologies and patient profiles.
Abstract:
Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.
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