This issue of Gastroenterology Clinics of North America is all about acute upper GI bleeding and is divided into two distinct sections: section I is devoted to nonvariceal upper GI bleeding and section II is devoted to variceal upper GI bleeding. Acute nonvariceal upper GI bleeding may originate from the esophagus, stomach, or duodenum, essentially anywhere proximal to the Ligament of Treitz. In Section I, Dr Gianluca Rotondano, Hospital Maresca, Torre del Greco, Italy, begins with a review of the epidemiology and diagnosis of acute nonvariceal upper GI bleeding. We then turn to patient presentation, risk stratification, and how to initially medically manage these bleeding patients. I am pleased to have one of our emergency medicine colleagues, Dr Andrew Meltzer, Department of Emergency Medicine, George Washington University, contribute this important article and provide a unique viewpoint from the emergency department where most of these patients initially present. As we all know, endoscopic hemostasis is the accepted standard of care for patients with acute nonvariceal upper GI bleeding. Moreover, peptic ulcer bleeding is the most common nonvariceal cause of acute upper GI bleeding; thus, Drs Yidan Lu, Yen-I Chen, and Alan Barkun from McGill University, Montreal, Canada, provide an in-depth review of the endoscopic management of peptic ulcer bleeding. Drs Eric Tjwa, I. Lisanne Holster, and Ernst Kuipers from the Erasmus Medical Center University Hospital, Rotterdam, The Netherlands, review the endoscopic management of all other causes of acute nonvariceal upper GI bleeding, and in addition, Drs Louis Wong Kee Song and Michael Levy from the Mayo Clinic, Rochester, Minnesota discuss emerging endoscopic hemostasis treatments, such as topical sprays and over-the-scope clipping devices. Although endoscopic hemostasis is very highly effective, there are unfortunately cases where bleeding is unable to be controlled or when significant rebleeding occurs that is not amenable to endoscopic therapy. Therefore, I have included two articles that provide insight into the question...what if endoscopic hemostasis fails? The first article, written by Drs Philip Wai Yan Chiu and James Yun Wong Lau, from Prince of Wales Hospital, The Chinese University of Hong Kong, focuses on tried and true surgical treatment options. The second article, by Dr Sujal Nanavati, University of California at San Francisco, Department of Radiology and Biomedical Imaging, addresses the alternative treatment strategy of angiographic embolization, which has now emerged as the often preferred salvage treatment strategy.
Dr. Gralnek is considered an authority on GI bleeding, and he has invited experts in their respective fields to contribute to this issue. The content is divided up between Acute Non-Variceal Upper GI Hemorrhage and Acute Lower Gastrointestinal Hemorrhage. Articles are devoted to the follow topics: Initial assessment, risk stratification and early management; Endotherapy of peptic ulcer bleeding; Endoscopic hemostasis of non-variceal, non-ulcer UGIH; Emerging endoscopic treatments for NVUGIH; The cutting edge: doppler ultrasound in guiding endoscopic hemostasis; The role of interventional radiology in NVUGIH; Managing antithrombotic agents in the setting of acute GI bleeding; Patient presentation, risk stratification and initial management; Colonoscopy: Diagnosis, timing and bowel preparation; The role of endoscopic hemostasis therapy; and Prevention of recurrent lower GI hemorrhage. Readers will come away with the most current clinical infomration on how to manage and prevent GI bleeding.
Clinical Gastrointestinal Endoscopy, 2nd Edition, by Drs. Gregory G. Ginsberg, Michael L. Kochman, Ian D. Norton, and Christopher J. Gostout, helps you master the latest endoscopic techniques and achieve optimal outcomes. See how to perform key nuances with procedural videos at www.expertconsult.com in addition to 1,000 photographs, upgraded endoscopic images, and anatomical drawings both in print and online. Written by some of today’s most prestigious specialists and with many new and fully updated chapters, this resource equips you to diagnose and treat the full range of GI disorders with state-of-the-art coverage of bariatric surgery, therapeutic EUS, device-assisted enteroscopy, image-guided therapy, intramural endotherapy, and much more. Get comprehensive details on a wide breadth of topics including anatomy, pathophysiology, and therapeutic management options in addition to the latest GI procedures and technologies. Advance your knowledge on the rapidly evolving state of clinical gastrointestinal endoscopy with expert multimedia guidance from some of today’s most prestigious specialists. Master new procedures with updates on the endoscopic management of bariatric surgery; EUS as a tool to direct endoscopic therapies; device-assisted enteroscopy for deep exploration of the small intestine; image-guided therapy to help detect cancer earlier; intramural endotherapy including the new POEM procedure; and much more. Keep current with both new and emerging technologies including the management of upper gastrointestinal familial adenomatous polyposis syndrome and ampullary tumors; post-bariatric endoscopy and endoscopic therapy; endoluminal bariatric techniques, and intramural/transmural endoscopy. See how to perform key procedures step by step with endoscopic videos at www.expertconsult.com, and access the complete text, online-only references, and all the illustrations. View techniques more clearly with upgraded endoscopic images and step-by-step illustrations in most chapters.
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