Non-variceal upper GI hemorrhage: Doorway to diagnosis

Endoscopy plays a central role in diagnosis and therapy of upper gastrointestinal bleeding. Safe and effective endoscopy depends on appropriate pre-procedure assessment and management. The initial evaluation of patients with severe upper gastrointestinal hemmorrhage depends upon effective communication between the Gastroenterologist and Intensivist. Rapid assessment of the patient, including focused history, vitals, and physical exam should be followed by initiation of resuscitation with well defined endpoints. Medical therapy aimed at correction of coagulopathy, elevation of gastric pH, and lowering portal pressure is appropriate during resuscitation and stabilization. Plans for airway management, patient monitoring, and management of complications must be in place prior to endoscopy, and all personnel involved in endoscopy in active gastrointestinal bleeding should be familiar with both the equipment and techniques which may be required to localize and control bleeding lesions.