Suggested Algorithm for Pts with Acute Upper GI Bleeding

Suggested Algorithm for Pts with Acute Upper GI Bleeding - Flowchart

«Flowchart»

Start

End

^a Intravenous bolus (80 mg) followed by infusion (8 mg/h) for 3 days; or oral or intravenous bolus (e.g., 80 mg) followed by intermittent high doses (e.g., 40-80 mg bid or 40 mg tid) for 3 days.Then twice-daily PPI on days 4-14 followed by once-daily PPI.

^b Intravenous 50 µg bolus followed by 50 µg/h infusion for 2-5 days.

^c Diet after endoscopy, assuming no nausea or vomiting.

^d Duration after endoscopy assuming pt stable without further bleeding or concurrent medical conditions requiring hospitalization; PPI, proton pump inhibitor.

Endoscopic Therapy

Endoscopic ligation

Endoscopic Therapy

Endoscopic ligation

Endoscopic Therapy

Endoscopic ligation

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Diagnosis

Ulcer

Endoscopic Diagnosis

Ulcer

Ulcer Ulcer

Endoscopic Diagnosis

Esophageal Varices

Endoscopic Diagnosis

Esophageal Varices

Esophageal Varices Esophageal Varices

Endoscopic Diagnosis

Mallory-Weiss Tear

Endoscopic Diagnosis

Mallory-Weiss Tear

Mallory-Weiss Tear Mallory-Weiss Tear

Endoscopic Diagnosis

Erosions

Endoscopic Diagnosis

Erosions

Erosions Erosions

Medical Therapy

Vasoactive drug (e.g., octreotide^b )

Medical Therapy

Vasoactive drug (e.g., octreotide^b )

Medical Therapy

Vasoactive drug (e.g., octreotide^b )

^b ^b

Diet^c

Clear liquids for ~2 days

Diet^c

Clear liquids for ~2 days

Diet^c

Diet^c ^c ^c

Clear liquids for ~2 days

Hospital Stay^d

Hospitalize ~3-5 days

Hospital Stay^d

Hospitalize ~3-5 days

Hospital Stay^d

Hospital Stay^d ^d ^d

Hospitalize ~3-5 days

Medical Therapy

Once-daily PPI therapy

Medical Therapy

Once-daily PPI therapy

Medical Therapy

Once-daily PPI therapy

Diet^c

Regular diet

Diet^c

Regular diet

Diet^c

Diet^c ^c ^c

Regular diet

Hospital Stay^d

Discharge after endoscopy

Hospital Stay^d

Discharge after endoscopy

Hospital Stay^d

Hospital Stay^d ^d ^d

Discharge after endoscopy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

Endoscopic therapy

Endoscopic Therapy

Endoscopic therapy

Endoscopic Therapy

Endoscopic therapy

Endoscopic Features

Active bleeding

Endoscopic Features

Active bleeding

Endoscopic Features

No active bleeding

Endoscopic Features

No active bleeding

Medical Therapy

Anti-emetic if ongoing nausea

Medical Therapy

Anti-emetic if ongoing nausea

Medical Therapy

Anti-emetic if ongoing nausea

Diet^c

Clear liquids for ~1 day

Diet^c

Clear liquids for ~1 day

Diet^c

Diet^c ^c ^c

Clear liquids for ~1 day

Hospital Stay^d

Hospitalize ~1-2 days

Hospital Stay^d

Hospitalize ~1-2 days

Hospital Stay^d

Hospital Stay^d ^d ^d

Hospitalize ~1-2 days

Medical Therapy

Anti-emetic if ongoing nausea

Medical Therapy

Anti-emetic if ongoing nausea

Medical Therapy

Anti-emetic if ongoing nausea

Diet^c

Regular diet

Diet^c

Regular diet

Diet^c

Diet^c ^c ^c

Regular diet

Hospital Stay^d

Discharge after endoscopy

Hospital Stay^d

Discharge after endoscopy

Hospital Stay^d

Hospital Stay^d ^d ^d

Discharge after endoscopy

Endoscopic Therapy

Endoscopic therapy

Endoscopic Therapy

Endoscopic therapy

Endoscopic Therapy

Endoscopic therapy

Endoscopic Therapy

May consider endoscopic therapy

Endoscopic Therapy

May consider endoscopic therapy

Endoscopic Therapy

May consider endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Therapy

No endoscopic therapy

Endoscopic Features

Active bleeding or visible vessel

Endoscopic Features

Active bleeding or visible vessel

Endoscopic Features

Adherent clot

Endoscopic Features

Adherent clot

Endoscopic Features

Flat pigmented spot

Endoscopic Features

Flat pigmented spot

Endoscopic Features

Clean base

Endoscopic Features

Clean base

Medical Therapy

Intensive PPI therapy^a

Medical Therapy

Intensive PPI therapy^a

Medical Therapy

Intensive PPI therapy^a

^a ^a

Diet^c

Clear liquids for ~2 days

Diet^c

Clear liquids for ~2 days

Diet^c

Diet^c ^c ^c

Clear liquids for ~2 days

Hospital Stay^d

Hospitalize 3 days

Hospital Stay^d

Hospitalize 3 days

Hospital Stay^d

Hospital Stay^d ^d ^d

Hospitalize 3 days

Medical Therapy

Intensive PPI therapy^a

Medical Therapy

Intensive PPI therapy^a

Medical Therapy

Intensive PPI therapy^a

^a ^a

Diet^c

Clear liquids for ~2 days

Diet^c

Clear liquids for ~2 days

Diet^c

Diet^c ^c ^c

Clear liquids for ~2 days

Hospital Stay^d

Hospitalize 3 days

Hospital Stay^d

Hospitalize 3 days

Hospital Stay^d

Hospital Stay^d ^d ^d

Hospitalize 3 days

Medical Therapy

Once-daily PPI therapy

Medical Therapy

Once-daily PPI therapy

Medical Therapy

Once-daily PPI therapy

Diet^c

Clear liquids for ~1 day

Diet^c

Clear liquids for ~1 day

Diet^c

Diet^c ^c ^c

Clear liquids for ~1 day

Hospital Stay^d

Hospitalize ~1-2 days

Hospital Stay^d

Hospitalize ~1-2 days

Hospital Stay^d

Hospital Stay^d ^d ^d

Hospitalize ~1-2 days

Medical Therapy

Once-daily PPI therapy

Medical Therapy

Once-daily PPI therapy

Medical Therapy

Once-daily PPI therapy

Diet^c

Regular diet

Diet^c

Regular diet

Diet^c

Diet^c ^c ^c

Regular diet

Hospital Stay^d

Discharge after endoscopy

Hospital Stay^d

Discharge after endoscopy

Hospital Stay^d

Hospital Stay^d ^d ^d

Discharge after endoscopy