Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Abstract

Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding using evidence‐based methods. The major cause of non‐variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug‐related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)‐related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first‐line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.

Effectiveness of Endoscopic Hemostasis with Soft Coagulation for Non-Variceal Upper Gastrointestinal Bleeding over a 12-Year Period

“…In this study, the percentage of UGIB caused by H. pylori -related peptic ulcer was decreased markedly between the 2 time periods of the study, which is compatible with the findings of previous studies [1,2,7,9,11]. Concomitant with the decrease in proportion of H. pylori -related peptic ulcer, the ratio of study patients with a previous history of peptic ulcer was lower in the second period.…”

“…Helicobacter pylori infection and the use of nonsteroidal, antiinflammatory drugs (NSAIDs), including aspirin, are the main causes of bleeding peptic ulcer diseases [1,2]. H. pylori infection was previously widespread in Japan, which resulted in a relatively low incidence of H. pylori -negative ulcers [3,4,5,6].…”

Questionnaire-Based Survey on Gastrointestinal Bleeding and Management of Antithrombotic Agents during Endoscopy Among Asian Countries

“…Administration of PPIs is reportedly useful for preventing low-dose aspirin prevent ulcer bleeding and death [10]. Moreover, PPI administration is recommended in the Japanese guidelines [11], and national health insurance treatment is considered to boost the high rate of prophylaxis administration in ­Japan.…”

Outcomes of Patients Undergoing Endoscopic Hemostasis for the Upper Gastrointestinal Bleeding Were Not Influenced by the Timing of Hospital Emergency Visits: A Situation Prevailing in Japan

“…The outpatients were further classified into 2 subgroups: those who visited the hospital emergency unit during regular hours (08: 30 to 17: 00 on weekdays; n  = 120) and those who visited the hospital emergency unit during off hours (17: 00 to 8: 30 on weekdays or on weekends/holidays; n  = 187). Hemostasis was achieved in all patients in the present study with endoscopic maneuvers including hemoclip application, pure ethanol injection and/or electrocoagulation, as previously described [1, 2, 11-13]. After endoscopic hemostasis, all patients were hospitalized and managed with conventional therapies, including nil oral intake, intravenous fluids and acid secretion inhibitors.…”

“…Emergency endoscopic hemostasis is the primary therapeutic approach to upper gastrointestinal bleeding, which is a serious life-threatening condition [1, 2]. Several studies in Western countries have indicated a “weekend effect” in therapeutic outcomes of endoscopic hemostasis in patients with upper gastrointestinal bleeding: those treated during off hours had a worse prognosis than those treated during regular hours [3-6].…”