A systematic review of failed endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding.
J Gastrointest Surg
; 28(3): 309-315, 2024 Mar.
Article
in En
| MEDLINE
| ID: mdl-38446116
ABSTRACT
BACKGROUND:
Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a surgical emergency, usually managed via endoscopy. Approximately 2% of patients will have another significant bleed after therapeutic endoscopy and may require either transarterial embolization (TAE) or surgery. In 2011, the National Institute for Health and Care Excellence guidelines recommended that TAE should be the preferred option offered in this setting.METHODS:
This study aimed to conduct an appraisal of guidelines on NVUGIB using the Appraisal of Guidelines for Research and Evaluation II tool. A specific review of their recommendations on the management of adult patients with failed endoscopic hemostasis that required TAE or surgery was conducted.RESULTS:
The quality of the guidelines was moderate; most could be recommended with changes. However, their recommendations regarding TAE vs surgery were widely heterogeneous. A closer review of the underpinning evidence showed that most studies were retrospective, with a small sample size and missing data.CONCLUSION:
Because of the heterogeneity in evidence, the decision regarding TAE vs surgery requires further research. Deciding between these modalities is primarily based on TAE availability and patient comorbidities. However, surgery should not be dismissed as a key option after failed endoscopic hemostasis.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hemostasis, Endoscopic
/
Embolization, Therapeutic
Limits:
Adult
/
Humans
Language:
En
Journal:
J Gastrointest Surg
/
J. gastrointest. surg
/
Journal of gastrointestinal surgery
Journal subject:
GASTROENTEROLOGIA
Year:
2024
Document type:
Article
Country of publication: