PMID- 33567467
OWN - NLM
STAT- MEDLINE
DCOM- 20210426
LR  - 20210426
IS  - 1438-8812 (Electronic)
IS  - 0013-726X (Linking)
VI  - 53
IP  - 3
DP  - 2021 Mar
TI  - Endoscopic diagnosis and management of nonvariceal upper gastrointestinal 
      hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) 
      Guideline - Update 2021.
PG  - 300-332
LID - 10.1055/a-1369-5274 [doi]
AB  - 1: ESGE recommends in patients with acute upper gastrointestinal hemorrhage 
      (UGIH) the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk 
      stratification. Patients with GBS </= 1 are at very low risk of rebleeding, 
      mortality within 30 days, or needing hospital-based intervention and can be 
      safely managed as outpatients with outpatient endoscopy.Strong recommendation, 
      moderate quality evidence. 2: ESGE recommends that in patients with acute UGIH 
      who are taking low-dose aspirin as monotherapy for secondary cardiovascular 
      prophylaxis, aspirin should not be interrupted. If for any reason it is 
      interrupted, aspirin should be re-started as soon as possible, preferably within 
      3-5 days.Strong recommendation, moderate quality evidence. 3: ESGE recommends 
      that following hemodynamic resuscitation, early (</= 24 hours) upper 
      gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high 
      quality evidence. 4: ESGE does not recommend urgent (</= 12 hours) upper GI 
      endoscopy since as compared to early endoscopy, patient outcomes are not 
      improved. Strong recommendation, high quality evidence. 5: ESGE recommends for 
      patients with actively bleeding ulcers (FIa, FIb), combination therapy using 
      epinephrine injection plus a second hemostasis modality (contact thermal or 
      mechanical therapy). Strong recommendation, high quality evidence. 6: ESGE 
      recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), 
      contact or noncontact thermal therapy, mechanical therapy, or injection of a 
      sclerosing agent, each as monotherapy or in combination with epinephrine 
      injection. Strong recommendation, high quality evidence. 7 : ESGE suggests that 
      in patients with persistent bleeding refractory to standard hemostasis 
      modalities, the use of a topical hemostatic spray/powder or cap-mounted clip 
      should be considered. Weak recommendation, low quality evidence. 8: ESGE 
      recommends that for patients with clinical evidence of recurrent peptic ulcer 
      hemorrhage, use of a cap-mounted clip should be considered. In the case of 
      failure of this second attempt at endoscopic hemostasis, transcatheter 
      angiographic embolization (TAE) should be considered. Surgery is indicated when 
      TAE is not locally available or after failed TAE. Strong recommendation, moderate 
      quality evidence. 9: ESGE recommends high dose proton pump inhibitor (PPI) 
      therapy for patients who receive endoscopic hemostasis and for patients with FIIb 
      ulcer stigmata (adherent clot) not treated endoscopically. (A): PPI therapy 
      should be administered as an intravenous bolus followed by continuous infusion 
      (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (B): High dose PPI 
      therapies given as intravenous bolus dosing (twice-daily) or in oral formulation 
      (twice-daily) can be considered as alternative regimens.Strong recommendation, 
      high quality evidence. 10: ESGE recommends that in patients who require ongoing 
      anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), 
      anticoagulation should be resumed as soon as the bleeding has been controlled, 
      preferably within or soon after 7 days of the bleeding event, based on 
      thromboembolic risk. The rapid onset of action of direct oral anticoagulants 
      (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this 
      context.Strong recommendation, low quality evidence.
CI  - European Society of Gastrointestinal Endoscopy. All rights reserved.
FAU - Gralnek, Ian M
AU  - Gralnek IM
AD  - Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel.
AD  - Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, 
      Israel.
FAU - Stanley, Adrian J
AU  - Stanley AJ
AD  - Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
FAU - Morris, A John
AU  - Morris AJ
AD  - Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
FAU - Camus, Marine
AU  - Camus M
AD  - Sorbonne University, Endoscopic Unit, Saint Antoine Hospital Assistance Publique 
      Hopitaux de Paris, Paris, France.
FAU - Lau, James
AU  - Lau J
AD  - Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong 
      Kong, Hong Kong SAR, China.
FAU - Lanas, Angel
AU  - Lanas A
AD  - Digestive Disease Services, University Clinic Hospital, University of Zaragoza, 
      IIS Aragon (CIBERehd), Spain.
FAU - Laursen, Stig B
AU  - Laursen SB
AUID- ORCID: 0000-0002-5268-6599
AD  - Department of Gastroenterology, Odense University Hospital, Odense, Denmark.
FAU - Radaelli, Franco
AU  - Radaelli F
AD  - Department of Gastroenterology, Valduce Hospital, Como, Italy.
FAU - Papanikolaou, Ioannis S
AU  - Papanikolaou IS
AD  - Hepatogastroenterology Unit, Second Department of Internal Medicine - 
      Propaedeutic, Medical School, National and Kapodistrian University of Athens, 
      Attikon University General Hospital, Athens, Greece.
FAU - Curdia Goncalves, Tiago
AU  - Curdia Goncalves T
AD  - Gastroenterology Department, Hospital da Senhora da Oliveira, Guimaraes, 
      Portugal.
AD  - School of Medicine, University of Minho, Braga/Guimaraes, Portugal.
AD  - ICVS/3B's-PT Government Associate Laboratory, Braga/Guimaraes, Portugal.
FAU - Dinis-Ribeiro, Mario
AU  - Dinis-Ribeiro M
AD  - Center for Research in Health Technologies and Information Systems (CINTESIS), 
      Faculty of Medicine, Porto, Portugal.
AD  - Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal.
FAU - Awadie, Halim
AU  - Awadie H
AUID- ORCID: 0000-0001-6586-5505
AD  - Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel.
FAU - Braun, Georg
AU  - Braun G
AD  - Medizinische Klinik 3, Universitatsklinikum Augsburg, Augsburg, Germany.
FAU - de Groot, Nicolette
AU  - de Groot N
AD  - Red Cross Hospital Beverwijk, Beverwijk, The Netherlands.
FAU - Udd, Marianne
AU  - Udd M
AD  - Gastroenterological Surgery, University of Helsinki and Helsinki University 
      Hospital, Helsinki, Finland.
FAU - Sanchez-Yague, Andres
AU  - Sanchez-Yague A
AD  - Gastroenterology Unit, Hospital Costa del Sol, Marbella, Spain.
AD  - Gastroenterology Department, Vithas Xanit International Hospital, Benalmadena, 
      Spain.
FAU - Neeman, Ziv
AU  - Neeman Z
AD  - Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, 
      Israel.
AD  - Diagnostic Imaging and Nuclear Medicine Institute, Emek Medical Center, Afula, 
      Israel.
FAU - van Hooft, Jeanin E
AU  - van Hooft JE
AD  - Department of Gastroenterology and Hepatology, Leiden University Medical Center, 
      Leiden, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20210210
PL  - Germany
TA  - Endoscopy
JT  - Endoscopy
JID - 0215166
SB  - IM
MH  - *Endoscopy, Gastrointestinal
MH  - Gastrointestinal Hemorrhage/diagnosis/etiology/therapy
MH  - *Hemostasis, Endoscopic
MH  - Humans
COIS- N. de Groot has worked with the NUMDL group on a national guideline on GI 
      bleeding (January to June 2017). M. Dinis-Ribeiro has provided consultancy to 
      Medtronic (October 2020); he is a Co-Editor-in-Chief of the journal Endoscopy. 
      I.M. Gralnek is a consultant to Boston Scientific, Medtronic, Motus GI, Vifor 
      Pharma, Simbionix, and Neurogastrx; he is also on the medical advisory board of 
      Motus GI and has received research funding from them and from OnePass, 
      AstraZeneca and CheckCap; he has also been a speaker for Vifor Pharma and 3D 
      Matrix. A. Lanas has provided consultancy to Bayer AG (2018 to 2020). A.J. Morris 
      serves on an advisory board for Medtronic (October 2020, ongoing); he is an 
      unpaid committee member and a guideline lead for the British Society of 
      Gastroenterology (BSG); he has received a fee for a commissioned article in 
      Medicine International journal (2019). I.S. Papanikolaou has received a 
      consultancy fee from Boston Scientific (25 January 2018 and 21 October 2018); he 
      has received travel grants from Takeda Hellas (10-13 October 2019 and 3-6 
      December 2020). F. Radaelli has served on an advisory board and been a speaker 
      for Pfizer/BMS (2019 to 2020); he has been a speaker for Boehringer Ingelheim 
      (2019 to 2020). A. Sanchez-Yague has received consultancy fees from Boston 
      Scientific (2017 to 2019). J.E. van Hooft has received lecture fees from 
      Medtronic (2014 to 2015, 2019) and Cook Medical (2019), and consultancy fees from 
      Boston Scientific (2014 to 2017); her department has received research grants 
      from Cook Medical (2014 to 2019), and Abbott (2014 to 2017). H. Awadie, G. Braun, 
      M. Camus, T. Curdia Goncalves, J. Lau, S.B. Laursen, Z. Neeman, A.J. Stanley, and 
      M. Udd declare no competing interests.
EDAT- 2021/02/11 06:00
MHDA- 2021/04/27 06:00
CRDT- 2021/02/10 20:10
PHST- 2021/02/11 06:00 [pubmed]
PHST- 2021/04/27 06:00 [medline]
PHST- 2021/02/10 20:10 [entrez]
AID - 10.1055/a-1369-5274 [doi]
PST - ppublish
SO  - Endoscopy. 2021 Mar;53(3):300-332. doi: 10.1055/a-1369-5274. Epub 2021 Feb 10.