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Acute gastrointestinal bleeding – a new approach to clinical and endoscopic management

Rey, Johannes W.a; Fischbach, Andreasb; Teubner, Daniela; Dieroff, Marcb; Heuberger, Dominika; Nguyen-Tat, Marcc; Manner, Hendrika; Kiesslich, Ralfa; Hoffman, Arthura

European Journal of Gastroenterology & Hepatology: May 2015 - Volume 27 - Issue 5 - p 483–491
doi: 10.1097/MEG.0000000000000343
Review Article

Overt or occult gastrointestinal bleeding is a frequently observed condition in routine gastroenterological practice. Occult gastrointestinal bleeding is usually a purely incidental finding, based on the discovery of iron deficiency anemia in the laboratory or blood in stool (a positive Hemoccult test). However, overt bleeding accompanied by the clinical features of tarry stool, hematemesis, or hematochezia may be a life-threatening condition, calling for immediate emergency management. In contrast to traumatology, algorithms of emergency and intensive medicine are not sufficiently validated yet for acute life-threatening bleeding. The purpose of this review was to present all established and new endoscopic hemostasis techniques and to evaluate their efficacy, as well as to provide the treating endoscopist with practical advice on how he/she could incorporate these procedures into acute medical management. The recommendations are based on inspection of the study results in the recent published literature, as well as emergency medicine algorithms in traumatology.

aDepartment of Internal Medicine II

bDepartment of Emergency, HSK Hospital, Wiesbaden

cFirst Department of Medicine, University Medical Center, Mainz, Germany

Correspondence to Johannes W. Rey, MD, Department of Internal Medicine II, HSK Hospital Wiesbaden, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany Tel: +49 151 157 91 000; fax: +49 611 43 2418; e-mail:

Received February 16, 2015

Accepted February 19, 2015

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