Guideline%20 upper%20gi%20bleeding

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  • 1. 2004 Consensus for Clinical Practice Guideline for the management of Upper GI Bleeding
  • 2. 2547 ISBN 974-92027-2-4 : . : . : . : . : . : . : .. : . : . 240/37 . . . 10700 . 0-2866-3002-3 . 0-2412-5320 2
  • 3. Upper GI bleeding 10-15 resuscitation antisecretory endoscopy consensus evidence-based 1-2 3
  • 4. - , () , () , , () , , () , , () .. 4
  • 5. Upper GI bleeding 1 Hematemesis / Melena 2 Initial Assessment and Resuscitation 3 Risk Stratification 3 A Low Risk 3 B High Risk PPI for Suspected Samotostain for 6 Non-variceal Suspected Variceal 7 4 Supportive Treatment and Monitoring Bleeding Bleeding Endoscopy Available 5 Elective Endoscopy Yes No 8 Ulcer bleeding Variceal Bleeding Others Refer 9 High risk 10 Low risk 16 Pharmacologic Therapy Endoscopic Hemostasis (Somatostatin or analogue) for Major Stigmata Hemorrhage 11 Endoscopy Feasible 15 Antisecretory 11 Endoscopy Feasible Therapeutic therapy Therapeutic 18 Yes No Yes No Continue Pharmacologic Therapy 13 17 EVL/EIS 19 SB 24-48 hrs Fail Success 12 Endoscopic Hemostasis Consult Surgeon or Refer Bleeding Stop Ongoing Bleed 22 20 21 Success Fail Success Fail OR Re-endoscopy Rebleed SB 24-48 hrs TIPS or Surgery 23 and Hemostasis or Refer 14 OR Pharmacologic Therapy and Re-endoscopy Fail Monitoring Rebleed OR EVL/EIS Success Rebleed 5
  • 6. 6 1 Hematemesis / Melena 2 Initial Assessment and Resuscitation 3 Risk Stratification 3 A Low Risk 3 B High Risk PPI for Suspected Samotostain for 6 Non-variceal Suspected Variceal 7 4 Supportive Treatment Bleeding Bleeding and Monitoring Endoscopy Available 5 Elective Endoscopy Yes No 8
  • 7. Yes No 8 Ulcer bleeding Variceal Bleeding Others Refer 9 High risk 10 Low risk Pharmacologic Therapy Endoscopic Hemostasis 16 (Somatostatin or analogue) for Major Stigmata Hemorrhage Therapeutic 15 Antisecretory 11 Therapeutic 11 Endoscopy Feasible therapy Endoscopy Feasible 18 Yes No Yes No Continue Pharmacologic Therapy 13 Endoscopic Consult Surgeon 17 EVL/EIS 19 SB 24-48 hrs Fail Success 12 Hemostasis or Refer7 Upper GI bleeding
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