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ACG Updates Guideline on Low-Risk GI Bleeding
The American College of Gastroenterology has issued an updated guideline on upper gastrointestinal (GI) bleeding, following research that shows the use of risk-assessment tools can identify patients with a low risk of adverse events, such as transfusion, hemostatic intervention, or death.
“We suggest risk assessment in the emergency department to identify very-low-risk patients (e.g., Glasgow-Blatchford score (GBS) = 0–1) who may be discharged with outpatient follow-up. For patients hospitalized with upper gastrointestinal bleeding, we suggest red blood cell transfusion at a threshold of 7 g/dL,” the authors reported.
Researchers performed systematic reviews of established clinical questions in order to improve and further develop evaluation of patients with upper GI bleeding using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The study confirmed low-risk patients can be considered at a GBS=0–1, and could meet the discharge requirements. This standard was previously held to GBS=0, as suggested in the 2012 American College of Gastroenterology (ACG) guidelines.
The authors recommend endoscopic therapy for ulcers with active spurting or oozing, as well as for visible vessels that are not bleeding. They further recommend that endoscopic therapy be conducted with bipolar electrocoagulation, heater probe, or absolute ethanol injection.
“After endoscopic hemostasis, high-dose proton pump inhibitor therapy is recommended continuously or intermittently for 3 days, followed by twice-daily oral proton pump inhibitor for the first 2 weeks of therapy after endoscopy. Repeat endoscopy is suggested for recurrent bleeding, and if endoscopic therapy fails, transcatheter embolization is suggested,” the authors concluded.
--Angelique Platas
Reference
Laine L, Barkun A, Saltzman J, Martel M, Leontiadis G. ACG clinical guideline: upper gastrointestinal and ulcer bleeding, Am J Gastroenterol. 2021;116(5):899-917
