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Sangrado gastrointestinal superior no variceal: avances y direcciones futuras en el manejo

Waku Hatta¹, Yohei Ogata¹, Takashi Chiba²

¹Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.

Clinical endoscopy

|December 18, 2025

Resumen

Esta revisión destaca las mejores prácticas actuales para el manejo del sangrado gastrointestinal superior no variceal (SGSNV), enfatizando la atención personalizada. Las estrategias clave incluyen la evaluación de riesgos, la transfusión restrictiva, el tratamiento endoscópico y el uso selectivo de la embolización arterial transcatéter (EAT) para casos refractarios.

Área de la Ciencia:

Gastroenterología; Medicina Interna; Manejo Clínico

Sus antecedentes:

Existen numerosas guías clínicas para el sangrado gastrointestinal superior no variceal (SGSNV), pero las recomendaciones varían significativamente. El manejo eficaz del SGSNV requiere un enfoque estructurado en múltiples etapas de atención.

Objetivo del estudio:

Revisar y sintetizar la evidencia más reciente para el manejo del SGSNV. Proporcionar una visión general completa de las estrategias de tratamiento del SGSNV, desde la evaluación inicial hasta el manejo del sangrado refractario.

Principales métodos:

Revisión sistemática de evidencia reciente sobre el manejo del SGSNV. Resumen estructurado en las fases pre-endoscópica, endoscópica, post-endoscópica y de sangrado refractario.

Principales resultados:

Pre-endoscopia: Las puntuaciones de riesgo ayudan a predecir la mortalidad; se recomienda la transfusión restrictiva (7-8 g/dL) y la eritromicina intravenosa. Endoscopia: Hay varias técnicas de hemostasia disponibles; la embolización arterial transcatéter (EAT) se prefiere a la cirugía para casos de endoscopia fallida. Post-endoscopia: La supresión de ácido en dosis altas es crucial; la endoscopia repetida es la primera línea para el resangrado, aunque se debate el momento óptimo de la EAT.

Conclusiones:

El manejo del SGSNV debe individualizarse debido a las diversas presentaciones clínicas. Se necesita más investigación para desarrollar estrategias de tratamiento personalizadas y basadas en evidencia para el SGSNV.

Palabras clave:

Endoscopia Hemorragia Mortalidad

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