UPDATE ON ENDOSCOPIC MANAGEMENT OF PEPTIC ULCER BLEEDING

Peptic ulcer bleeding is a common medical emergency and still a potentially fatal condition. It is the best managed using a multidisciplinary approach by a team with medical, endoscopic and surgical expertise. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of presentation. Endoscopic therapy is indicated for patients with high-risk stigmata, in particular those with active bleeding and visible vessels. A combination of proton pump inhibitors and endoscopic therapy (using a combination of injection and mechanical hemostasis) offers the best chance of hemostasis for those with active bleeding ulcers. The application of an ulcer-covering hemospray is a new promising tool. High dose proton pump inhibitors should be administered intravenously for 72 h in high-risk patients. Helicobacter pylori should be tested for in all patients with peptic ulcer bleeding and eradicated if positive