Upper Gastrointestinal and Ulcer Bleeding(beta)
We suggest that patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) who are classified as very low risk, defined as a risk assessment score with ≤1% false negative rate for the outcome of hospital-based intervention or death (e.g., Glasgow-Blatchford score = 0–1), be discharged with outpatient follow-up rather than admitted to hospital.
Red Blood Cell Transfusion
Pre-endoscopic Medical Therapy
Endoscopy for UGIB
We recommend endoscopic therapy in patients with UGIB due to ulcers with active spurting, active oozing, and non-bleeding visible vessels.
We recommend endoscopic hemostatic therapy with bipolar electrocoagulation, heater probe, or injection of absolute ethanol for patients with UGIB due to ulcers.
We suggest endoscopic hemostatic therapy with clips, argon plasma coagulation, or soft monopolar electrocoagulation for patients with UGIB due to ulcers.
We recommend that epinephrine injection not be used alone for patients with UGIB due to ulcers but rather in combination with another hemostatic modality.
We suggest endoscopic hemostatic therapy with hemostatic powder spray TC-325 for patients with actively bleeding ulcers.
Hemostatic Therapy for Bleeding Ulcers
We recommend high-dose PPI therapy given continuously or intermittently for 3 d after successful endoscopic hemostatic therapy of a bleeding ulcer.
How strong is the ACG's recommendation?