Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

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.