PMID- 31392464
OWN - NLM
STAT- MEDLINE
DCOM- 20191014
LR  - 20200225
IS  - 1433-0385 (Electronic)
IS  - 0009-4722 (Linking)
VI  - 90
IP  - 8
DP  - 2019 Aug
TI  - [Treatment of nonvariceal upper gastrointestinal bleeding: 
      endoluminal-endovascular-surgical].
PG  - 607-613
LID - 10.1007/s00104-019-0948-7 [doi]
AB  - BACKGROUND: Nonvariceal upper gastrointestinal bleeding (UGIB) has a high 
      mortality. Hematemesis sometimes with melena are the leading clinical symptoms. 
      Peptic ulcers and (erosive) inflammation are common, whereas Mallory-Weiss 
      syndrome, neoplasms, angiodysplasia and diffuse UGIB are less common. PROBLEM: A 
      risk stratification is based on the medical history, clinical presentation and 
      laboratory tests, which are considered in the Glasgow-Blatchford score; however, 
      which treatment approach is optimal? RESULTS: After stabilisation under 
      restricted transfusion indications, temporary stoppage of anticoagulants and 
      optimized coagulation is beneficial and proton pump inhibitors (PPI) should be 
      started. Prokinetics improve the endoscopic conditions in UGIB. The use of an 
      endoscopic Doppler probe optimizes localization of the bleeding site. The use of 
      the Forrest classification and Helicobacter pylori diagnostics are recommended. 
      Mechanical (clips, injection), thermal (argon plasma coagulation, APC) and 
      topical (hemostatic powder) endoscopic treatment procedures are available. 
      Endoluminal hemostasis is very effective. Only clip application is suitable as 
      monotherapy whereas all other endoscopic options should be combined. Angiography 
      followed by transarterial embolization (TAE) can be used for therapy. Despite the 
      high primary success rate, the risk of rebleeding is high. Surgery as the primary 
      treatment is rarely necessary, although effective. Compared to TAE complications 
      are higher, but there is no difference regarding mortality. CONCLUSION: Endoscopy 
      remains the gold standard for the initial diagnostics and treatment of UGIB. In 
      cases of rebleeding repeated endoscopy is recommended. With persistent UGIB an 
      endovascular procedure should be evaluated. Surgery remains an important salvage 
      option.
FAU - Schweizer, U
AU  - Schweizer U
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Universitatsklinikum Tubingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Deutschland. 
      ulrich.schweizer@med.uni-tuebingen.de.
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Zentrum fur Medizinische Forschung, Experimentelle Chirurgische Endoskopie, 
      Universitatsklinikum Tubingen, Tubingen, Deutschland. 
      ulrich.schweizer@med.uni-tuebingen.de.
FAU - Grund, K E
AU  - Grund KE
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Universitatsklinikum Tubingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Deutschland.
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Zentrum fur Medizinische Forschung, Experimentelle Chirurgische Endoskopie, 
      Universitatsklinikum Tubingen, Tubingen, Deutschland.
FAU - Fundel, J
AU  - Fundel J
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Zentrum fur Medizinische Forschung, Experimentelle Chirurgische Endoskopie, 
      Universitatsklinikum Tubingen, Tubingen, Deutschland.
FAU - Wichmann, D
AU  - Wichmann D
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Universitatsklinikum Tubingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Deutschland.
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Zentrum fur Medizinische Forschung, Experimentelle Chirurgische Endoskopie, 
      Universitatsklinikum Tubingen, Tubingen, Deutschland.
FAU - Konigsrainer, A
AU  - Konigsrainer A
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Universitatsklinikum Tubingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Deutschland.
AD  - Universitatsklinik fur Allgemeine, Viszeral- und Transplantationschirurgie, 
      Zentrum fur Medizinische Forschung, Experimentelle Chirurgische Endoskopie, 
      Universitatsklinikum Tubingen, Tubingen, Deutschland.
LA  - ger
PT  - Journal Article
PT  - Review
TT  - Therapie der nichtvarikosen oberen gastrointestinalen Blutung: endoluminal - 
      endovaskular - chirurgisch.
PL  - Germany
TA  - Chirurg
JT  - Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen
JID - 16140410R
RN  - 0 (Anticoagulants)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Anticoagulants
MH  - Blood Transfusion
MH  - Endoscopy, Gastrointestinal
MH  - Gastrointestinal Hemorrhage/surgery
MH  - *Hemostasis, Endoscopic
MH  - Humans
MH  - Proton Pump Inhibitors
OTO - NOTNLM
OT  - Endoscopic diagnostics
OT  - Endovascular treatment
OT  - Intervention
OT  - Recurrent bleeding risk
OT  - Surgery
EDAT- 2019/08/09 06:00
MHDA- 2019/10/15 06:00
CRDT- 2019/08/09 06:00
PHST- 2019/08/09 06:00 [entrez]
PHST- 2019/08/09 06:00 [pubmed]
PHST- 2019/10/15 06:00 [medline]
AID - 10.1007/s00104-019-0948-7 [pii]
AID - 10.1007/s00104-019-0948-7 [doi]
PST - ppublish
SO  - Chirurg. 2019 Aug;90(8):607-613. doi: 10.1007/s00104-019-0948-7.