When the patient has been resuscitated, then treatment of the underlying cause of the haemorrhage may be commenced.
Management of non-variceal bleeding
- adrenaline should not be used as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding
- for the endoscopic treatment of non-variceal upper gastrointestinal bleeding, use one of the following:
- a mechanical method (for example, clips) with or without adrenaline
- thermal coagulation with adrenaline fibrin or
- thrombin with adrenaline
- interventional radiology should be offered to unstable patients who re-bleed after endoscopic treatment
- refer urgently for surgery if interventional radiology is not promptly available
Management of variceal bleeding
- terlipressin should be offered to patients with suspected variceal bleeding at presentation. Stop treatment after definitive haemostasis has been achieved, or after 5 days, unless there is another indication for its use
- prophylactic antibiotic therapy should be offered at presentation to patients with suspected or confirmed variceal bleeding
- oesophageal varices
- use band ligation in patients with upper gastrointestinal bleeding from oesophageal varices
- consider transjugular intrahepatic portosystemic shunts (TIPS) if bleeding from oesophageal varices is not controlled by band ligation.
- gastric varices
- endoscopic injection of N-butyl-2-cyanoacrylate should be offered to patients with upper gastrointestinal bleeding from gastric varices
- TIPS should be offered if bleeding from gastric varices is not controlled by endoscopic injection of N-butyl-2-cyanoacrylate
Reference:
- NICE (August 2016). Acute Upper GI bleeding.