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Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018
  1. Joseph JY Sung1,
  2. Philip WY Chiu1,
  3. Francis K L Chan1,
  4. James YW Lau1,
  5. Khean-lee Goh2,
  6. Lawrence HY Ho3,
  7. Hwoon-young Jung4,
  8. Jose D Sollano5,
  9. Takuji Gotoda6,
  10. Nageshwar Reddy7,
  11. Rajvinder Singh8,
  12. Kentaro Sugano9,
  13. Kai-chun Wu10,
  14. Chun-Yin Wu11,
  15. David J Bjorkman12,
  16. Dennis M Jensen13,
  17. Ernst J Kuipers14,
  18. Angel Lanas15
  1. 1 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
  2. 2 Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
  3. 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  4. 4 University of Ulsan College of Medicine, Ulsan, South Korea
  5. 5 UST Hospital, University of Santo Tomas, Manila, Philippines
  6. 6 Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
  7. 7 Asian Institute of Gastroenterology, Asian Healthcare Foundation, Hyderabad, India
  8. 8 Department of Medicine, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia
  9. 9 Department of Medicine, Jichi Medical School, Shimotsuke, Japan
  10. 10 State Key Laboratory of Cancer Biology, Xijing Hospital of Digestive Diseases, Xi’an, China
  11. 11 China Medical University, Taichung, Taiwan
  12. 12 University of Utah College of Health, Salt Lake City, Utah, USA
  13. 13 University of California, Los Angeles, California, USA
  14. 14 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  15. 15 Department of Gastroenterology, University Hospital, Zaragoza, Spain
  1. Correspondence to Professor Joseph JY Sung, Institute of Digestive Disease, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China; jjysung{at}cuhk.edu.hk

Abstract

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

  • gastrointestinal bleeding
  • endoscopy

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Footnotes

  • Contributors Study design: JJYS; literature review: JJYS, PCYC, FKLC, JYWL, John Wong and Moe Kyaw; draft of the manuscript: JJYS; revision of the manuscript: all authors.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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