Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review

Abstract

Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.

Keywords: Bedside endoscopy; Emergency bowel preparation; Endoscopic bleeding control; Endoscopy; Gastrointestinal bleeding; Second-look endoscopy.

Figure 1

Flowchart of assessment and management of patients with suspicious gastrointestinal bleeding. GI: Gastrointestinal; EGD: Esophagogastroduodenoscopy; NSAIDs: Non-steroidal anti-inflammatory drugs; ICU: Intensive care unit; EVL: Endoscopic variceal ligation; UGIB: Upper gastrointestinal bleeding; LGIB: Lower gastrointestinal bleeding.