1: ESGE recommends in patients with acute upper
gastrointestinal hemorrhage (UGIH) the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2: ESGE recommends that in patients with acute UGIH who are taking low-dose
aspirin as monotherapy for secondary cardiovascular prophylaxis,
aspirin should not be interrupted. If for any reason it is interrupted,
aspirin should be re-started as soon as possible, preferably within 3-5 days.Strong recommendation, moderate quality evidence. 3: ESGE recommends that following hemodynamic
resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4: ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5: ESGE recommends for patients with actively
bleeding ulcers (FIa, FIb), combination
therapy using
epinephrine injection plus a second hemostasis modality (contact thermal or mechanical
therapy). Strong recommendation, high quality evidence. 6: ESGE recommends for patients with an
ulcer with a nonbleeding visible vessel (
FIIa), contact or noncontact thermal
therapy, mechanical
therapy, or injection of a
sclerosing agent, each as monotherapy or in combination with
epinephrine injection. Strong recommendation, high quality evidence. 7 : ESGE suggests that in patients with persistent
bleeding refractory to standard hemostasis modalities, the use of a topical
hemostatic spray/
powder or cap-mounted
clip should be considered. Weak recommendation, low quality evidence. 8: ESGE recommends that for patients with clinical evidence of recurrent
peptic ulcer hemorrhage, use of a cap-mounted
clip should be considered. In the case of failure of this second attempt at
endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9: ESGE recommends high dose
proton pump inhibitor (PPI)
therapy for patients who receive
endoscopic hemostasis and for patients with FIIb
ulcer stigmata (adherent clot) not treated endoscopically. (A): PPI
therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (B): High dose PPI
therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10: ESGE recommends that in patients who require ongoing anticoagulation
therapy following acute NVUGIH (e. g.,
peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the
bleeding has been controlled, preferably within or soon after 7 days of the
bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral
anticoagulants (DOACS), as compared to
vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.