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Mistakes in upper gastrointestinal bleeding and how to avoid them

Bjorn Rembacken

Summary

AI Generated

Upper gastrointestinal bleeding management remains challenging with stable 30-year mortality rates despite advances in endoscopy and an aging patient population with more comorbidities.

  • The 30-day mortality rate for patients with bleeding ulcers and varices was 22% over a five-year period in Leeds, though published mortality rates vary widely due to inclusion of healthier patients without significant bleeding.
  • Standard of care involves offering emergency gastroscopy within 24 hours, a benchmark not always met in the UK.
  • Early endoscopy is safe, reduces hospital stay length, and decreases the need for emergency surgery, though strong evidence that it directly saves lives is lacking.
  • Distinguishing patients with significant bleeding from those with other causes of illness and hypotension remains difficult in clinical practice.
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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Targownik LE and Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 2006; 4: 1459–1466. [Link]
2.
Zhao Y and Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006. HCUP Statistical Brief #65. December, 2008. Agency for Healthcare Research and Quality, Rockville, MD. [Link]
3.
van Leerdam ME, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98: 1494–1499. [Link]
4.
St. Elsewhere’s NHS Trust. UK comparative audit of upper gastrointestinal bleeding and the use of blood December 2007. [Link]
5.
Mohammed N, et al. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience. Endosc Int Open 2016; 4: E282–E286. [Link]
6.
Hearnshaw SA, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327–1335. [Link]
7.
Barkun A, et al; RUGBE Investigators. The Canadian registry on nonvariceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004; 99: 1238–1246. [Link]
8.
Cipolletta L, et al. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 2002; 55: 1–5. [Link]
9.
Spiegel BM, Vakil NB and Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393–1404. [Link]
10.
Hay JA, et al. Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage. JAMA 1997; 278: 2151–2156. [Link]
11.
Lin HJ, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol 1996; 22: 267–271. [Link]
12.
Lee JG, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755–761. [Link]
13.
Bjorkman DJ, et al. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60: 1–8. [Link]
14.
Blatchford O, Murray WR and Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000; 356: 1318–1321. [Link]
15.
Steg PG, et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS ONE 2012; 7: e36284. [Link]
16.
Daly CA, et al. Inadequate control of heart rate in patients with stable angina: results from the European heart survey. Postgrad Med J 2010; 86: 212–217. [Link]
17.
Stanley AJ, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet 2009; 373: 42–47. [Link]
18.
Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–321. [Link]
19.
National Institute for Health and Clinical Excellence. Clinical Guideline 141: Acute upper gastrointestinal bleeding: management. 2012. [Link]
20.
Baradarian R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastro 2004; 99: 619–622. [Link]
21.
Marik PE and Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667–2674. [Link]
22.
Kim P, et al. Impact of acute blood loss anemia and red blood cell transfusion on mortality after percutaneous coronary intervention. Clin Cardiol 2007; 30: II-35–ll-43. [Link]
23.
Blair SD, et al. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986; 73: 783–785. [Link]
24.
Fortune JB, et al. Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 1987; 27: 243–249. [Link]
25.
Casutt M, et al. Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med 1999; 27: 2194–2200. [Link]
26.
Dietrich KA, et al. Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990; 18: 940–944. [Link]
27.
Tsai AG, Cabrales P and Intaglietta M. Microvascular perfusion upon exchange transfusion with stored red blood cells in normovolemic anemic conditions. Transfusion 2004; 44: 1626–1234. [Link]
28.
Koch CG, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–1239. [Link]
29.
Oliveira RP, et al. Clinical review: hypertonic saline resuscitation in sepsis. Crit Care 2002; 6: 418–423. [Link]
30.
American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med 2004; 170: 1247–1259. [Link]
31.
Perel P, Roberts I and Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013; 2: CD000567. [Link]
32.
Zarychanski R, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013; 309: 678–688. [Link]
33.
Annane S, et.al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock. The CRISTAL randomized trial. JAMA 2013; 310: 1809–1817. [Link]
34.
Perel P and Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. In The Cochrane Library, 2007, Issue 4. London: John Wiley & Sons Ltd.
35.
SIGN. Guideline 105. Management of acute upper and lower gastrointestinal bleeding. September 2008. [Link]
36.
Gralnek IM, et.al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1–a46. [Link]
37.
Kwan I, et al. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2014; 3: CD002245. [Link]
38.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11–21. [Link]
39.
Jairath V et.al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015; 386: 137–144. [Link]
40.
American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105: 198–208. [Link]
41.
Carson JL, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J 2013; 165: 964–71.e1.
42.
Rubin A, Murdoch M and Nelson DB, Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest Endosc 2003; 58: 369–373. [Link]
43.
Holster IL, et al. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 2013; 145: 105–112. [Link]
44.
Choudari CP, Rajgopal C and Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut 1994; 35: 464–466. [Link]
45.
Jairath V, et al. Surgery or embolisation after failed endoscopic therapy. Br J Surg 2012; 99: 1672–1680. [Link]
46.
Chen WC, et al. Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome. BioMed Res Int 2014; 2014: 463767. [Link]
47.
Blacker DJ, Wijdicks EFM and McClelland RL. Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy. Neurology 2003; 61: 964–968. [Link]
48.
Sung JJY, et al. Continuation of low dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1–9. [Link]
49.
Beving H, et al. Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul Fibrinolysis 1996; 7: 80–84. [Link]
50.
Fatah K, et al. Acetylsalicylic acid may protect the patient by increasing fibrin gel porosity. Is withdrawing of treatment harmful to the patient? Eur Heart J 1996; 17: 1362–1366. [Link]
51.
Vial JH, McLeod LJ and Roberts MS. Rebound elevation in urinary thromboxane B2 and 6-keto-PGF1 alpha excretion after aspirin withdrawal. Adv Prostaglandin Thromboxane Leukot Res 1991; 21A: 157–160. [Link]
52.
Barkun AN, et al. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses. Gastrointest Endosc 2009; 69: 786–799.
53.
Jensen DM, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002; 123: 407–413. [Link]
54.
Laine L, Stein C and Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc 1996; 43: 107–110. [Link]
55.
Sung JJ, et al. The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison. Ann Intern Med 2003; 139: 237–243. [Link]
56.
Kahi CJ, et al. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 2005; 129: 855–862. [Link]
57.
Laine L and McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009; 7: 33–47. [Link]
58.
Sung JJ, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011; 43: 291–295.

Abstract

Dealing with upper gastrointestinal (UGI) bleeding is complex and challenging, especially since distinguishing patients with significant bleeding from those with other causes of illness and hypotension can be difficult. Despite these diagnostic challenges and the increasing age and comorbidities of patients, the mortality rate from UGI bleeding has remained stable over the past 30 years. Mortality rates vary in published studies, often due to the inclusion of healthier patients without significant bleeding. The best way to assess outcomes is by focusing on patients with bleeding ulcers and varices, with a noted 30-day mortality rate of 22% in such cases over a five-year period in Leeds. The standard of care for emergency GI bleeding involves offering an emergency gastroscopy within 24 hours, although this benchmark is not always met in the UK. Early endoscopy is known to be safe, reduces hospital stay length, and decreases the need for emergency surgery, though there is no strong evidence that it directly saves lives. This may be because many studies include patients without significant bleeding. Drawing on years of clinical experience, this discussion will focus on common mistakes made in managing UGI bleeding.

Topics

Digestive Oncology Endoscopy Stomach & H. Pylori

Citation

Rembacken BJ. Mistakes in upper gastrointestinal bleeding and how to avoid them. UEG Education 2016: 16: 15–19.

Published

2016

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UEG Podcast Episode
UEG Podcast
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Malignancy in IBD with Hannah Gordon

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Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Digestive Oncology IBD

Published

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Mistakes in newly diagnosed Crohn's disease and how to avoid them

Joana Roseira, Nurulamin Noor

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Targownik LE and Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 2006; 4: 1459–1466. [Link]
2.
Zhao Y and Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006. HCUP Statistical Brief #65. December, 2008. Agency for Healthcare Research and Quality, Rockville, MD. [Link]
3.
van Leerdam ME, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98: 1494–1499. [Link]
4.
St. Elsewhere’s NHS Trust. UK comparative audit of upper gastrointestinal bleeding and the use of blood December 2007. [Link]
5.
Mohammed N, et al. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience. Endosc Int Open 2016; 4: E282–E286. [Link]
6.
Hearnshaw SA, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327–1335. [Link]
7.
Barkun A, et al; RUGBE Investigators. The Canadian registry on nonvariceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004; 99: 1238–1246. [Link]
8.
Cipolletta L, et al. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 2002; 55: 1–5. [Link]
9.
Spiegel BM, Vakil NB and Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393–1404. [Link]
10.
Hay JA, et al. Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage. JAMA 1997; 278: 2151–2156. [Link]
11.
Lin HJ, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol 1996; 22: 267–271. [Link]
12.
Lee JG, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755–761. [Link]
13.
Bjorkman DJ, et al. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60: 1–8. [Link]
14.
Blatchford O, Murray WR and Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000; 356: 1318–1321. [Link]
15.
Steg PG, et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS ONE 2012; 7: e36284. [Link]
16.
Daly CA, et al. Inadequate control of heart rate in patients with stable angina: results from the European heart survey. Postgrad Med J 2010; 86: 212–217. [Link]
17.
Stanley AJ, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet 2009; 373: 42–47. [Link]
18.
Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–321. [Link]
19.
National Institute for Health and Clinical Excellence. Clinical Guideline 141: Acute upper gastrointestinal bleeding: management. 2012. [Link]
20.
Baradarian R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastro 2004; 99: 619–622. [Link]
21.
Marik PE and Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667–2674. [Link]
22.
Kim P, et al. Impact of acute blood loss anemia and red blood cell transfusion on mortality after percutaneous coronary intervention. Clin Cardiol 2007; 30: II-35–ll-43. [Link]
23.
Blair SD, et al. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986; 73: 783–785. [Link]
24.
Fortune JB, et al. Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 1987; 27: 243–249. [Link]
25.
Casutt M, et al. Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med 1999; 27: 2194–2200. [Link]
26.
Dietrich KA, et al. Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990; 18: 940–944. [Link]
27.
Tsai AG, Cabrales P and Intaglietta M. Microvascular perfusion upon exchange transfusion with stored red blood cells in normovolemic anemic conditions. Transfusion 2004; 44: 1626–1234. [Link]
28.
Koch CG, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–1239. [Link]
29.
Oliveira RP, et al. Clinical review: hypertonic saline resuscitation in sepsis. Crit Care 2002; 6: 418–423. [Link]
30.
American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med 2004; 170: 1247–1259. [Link]
31.
Perel P, Roberts I and Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013; 2: CD000567. [Link]
32.
Zarychanski R, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013; 309: 678–688. [Link]
33.
Annane S, et.al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock. The CRISTAL randomized trial. JAMA 2013; 310: 1809–1817. [Link]
34.
Perel P and Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. In The Cochrane Library, 2007, Issue 4. London: John Wiley & Sons Ltd.
35.
SIGN. Guideline 105. Management of acute upper and lower gastrointestinal bleeding. September 2008. [Link]
36.
Gralnek IM, et.al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1–a46. [Link]
37.
Kwan I, et al. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2014; 3: CD002245. [Link]
38.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11–21. [Link]
39.
Jairath V et.al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015; 386: 137–144. [Link]
40.
American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105: 198–208. [Link]
41.
Carson JL, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J 2013; 165: 964–71.e1.
42.
Rubin A, Murdoch M and Nelson DB, Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest Endosc 2003; 58: 369–373. [Link]
43.
Holster IL, et al. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 2013; 145: 105–112. [Link]
44.
Choudari CP, Rajgopal C and Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut 1994; 35: 464–466. [Link]
45.
Jairath V, et al. Surgery or embolisation after failed endoscopic therapy. Br J Surg 2012; 99: 1672–1680. [Link]
46.
Chen WC, et al. Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome. BioMed Res Int 2014; 2014: 463767. [Link]
47.
Blacker DJ, Wijdicks EFM and McClelland RL. Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy. Neurology 2003; 61: 964–968. [Link]
48.
Sung JJY, et al. Continuation of low dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1–9. [Link]
49.
Beving H, et al. Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul Fibrinolysis 1996; 7: 80–84. [Link]
50.
Fatah K, et al. Acetylsalicylic acid may protect the patient by increasing fibrin gel porosity. Is withdrawing of treatment harmful to the patient? Eur Heart J 1996; 17: 1362–1366. [Link]
51.
Vial JH, McLeod LJ and Roberts MS. Rebound elevation in urinary thromboxane B2 and 6-keto-PGF1 alpha excretion after aspirin withdrawal. Adv Prostaglandin Thromboxane Leukot Res 1991; 21A: 157–160. [Link]
52.
Barkun AN, et al. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses. Gastrointest Endosc 2009; 69: 786–799.
53.
Jensen DM, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002; 123: 407–413. [Link]
54.
Laine L, Stein C and Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc 1996; 43: 107–110. [Link]
55.
Sung JJ, et al. The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison. Ann Intern Med 2003; 139: 237–243. [Link]
56.
Kahi CJ, et al. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 2005; 129: 855–862. [Link]
57.
Laine L and McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009; 7: 33–47. [Link]
58.
Sung JJ, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011; 43: 291–295.

Abstract

Crohn’s disease (CD) is a chronic inflammatory bowel condition that can present with a wide range of intestinal and extra-intestinal manifestations. This condition can develop at any age and have a significant impact and impairment on quality of life for individuals including on relationships, educational attainment and work productivity. In particular, the time around and after diagnosis often involves the most upheaval for patients, and equally the biggest opportunity for effective intervention. Several recent advances have had a major impact on optimal management of patients with newly diagnosed CD. Here, we discuss the mistakes that are commonly made when managing patients presenting with a new diagnosis of CD. We summarise the evidence base and offer helpful and pragmatic tips for practising clinicians.

Topics

IBD

Citation

Roseira J and Noor N. Mistakes in newly diagnosed crohn's disease and how to avoid them. UEG Education 2025; 25: 18-23.

Published

2025

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Mistakes in endoscopy and how to avoid them

Mistakes in endoscopy and how to avoid them

Jacques Deviere Jacques Deviere, Arnaud Lemmers

Mistakes in colonoscopy and how to avoid them

Mistakes in colonoscopy and how to avoid them

Manmeet Matharoo Manmeet Matharoo, Siwan Thomas-Gibson, Srivathsan Ravindran

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European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma Abdulbaqi Al-Toma

UEG Mistakes In Articles
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Mistakes in endoscopy and how to avoid them

Jacques Deviere, Arnaud Lemmers

Summary

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Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Targownik LE and Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 2006; 4: 1459–1466. [Link]
2.
Zhao Y and Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006. HCUP Statistical Brief #65. December, 2008. Agency for Healthcare Research and Quality, Rockville, MD. [Link]
3.
van Leerdam ME, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98: 1494–1499. [Link]
4.
St. Elsewhere’s NHS Trust. UK comparative audit of upper gastrointestinal bleeding and the use of blood December 2007. [Link]
5.
Mohammed N, et al. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience. Endosc Int Open 2016; 4: E282–E286. [Link]
6.
Hearnshaw SA, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327–1335. [Link]
7.
Barkun A, et al; RUGBE Investigators. The Canadian registry on nonvariceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004; 99: 1238–1246. [Link]
8.
Cipolletta L, et al. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 2002; 55: 1–5. [Link]
9.
Spiegel BM, Vakil NB and Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393–1404. [Link]
10.
Hay JA, et al. Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage. JAMA 1997; 278: 2151–2156. [Link]
11.
Lin HJ, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol 1996; 22: 267–271. [Link]
12.
Lee JG, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755–761. [Link]
13.
Bjorkman DJ, et al. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60: 1–8. [Link]
14.
Blatchford O, Murray WR and Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000; 356: 1318–1321. [Link]
15.
Steg PG, et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS ONE 2012; 7: e36284. [Link]
16.
Daly CA, et al. Inadequate control of heart rate in patients with stable angina: results from the European heart survey. Postgrad Med J 2010; 86: 212–217. [Link]
17.
Stanley AJ, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet 2009; 373: 42–47. [Link]
18.
Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–321. [Link]
19.
National Institute for Health and Clinical Excellence. Clinical Guideline 141: Acute upper gastrointestinal bleeding: management. 2012. [Link]
20.
Baradarian R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastro 2004; 99: 619–622. [Link]
21.
Marik PE and Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667–2674. [Link]
22.
Kim P, et al. Impact of acute blood loss anemia and red blood cell transfusion on mortality after percutaneous coronary intervention. Clin Cardiol 2007; 30: II-35–ll-43. [Link]
23.
Blair SD, et al. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986; 73: 783–785. [Link]
24.
Fortune JB, et al. Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 1987; 27: 243–249. [Link]
25.
Casutt M, et al. Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med 1999; 27: 2194–2200. [Link]
26.
Dietrich KA, et al. Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990; 18: 940–944. [Link]
27.
Tsai AG, Cabrales P and Intaglietta M. Microvascular perfusion upon exchange transfusion with stored red blood cells in normovolemic anemic conditions. Transfusion 2004; 44: 1626–1234. [Link]
28.
Koch CG, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–1239. [Link]
29.
Oliveira RP, et al. Clinical review: hypertonic saline resuscitation in sepsis. Crit Care 2002; 6: 418–423. [Link]
30.
American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med 2004; 170: 1247–1259. [Link]
31.
Perel P, Roberts I and Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013; 2: CD000567. [Link]
32.
Zarychanski R, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013; 309: 678–688. [Link]
33.
Annane S, et.al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock. The CRISTAL randomized trial. JAMA 2013; 310: 1809–1817. [Link]
34.
Perel P and Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. In The Cochrane Library, 2007, Issue 4. London: John Wiley & Sons Ltd.
35.
SIGN. Guideline 105. Management of acute upper and lower gastrointestinal bleeding. September 2008. [Link]
36.
Gralnek IM, et.al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1–a46. [Link]
37.
Kwan I, et al. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2014; 3: CD002245. [Link]
38.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11–21. [Link]
39.
Jairath V et.al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015; 386: 137–144. [Link]
40.
American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105: 198–208. [Link]
41.
Carson JL, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J 2013; 165: 964–71.e1.
42.
Rubin A, Murdoch M and Nelson DB, Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest Endosc 2003; 58: 369–373. [Link]
43.
Holster IL, et al. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 2013; 145: 105–112. [Link]
44.
Choudari CP, Rajgopal C and Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut 1994; 35: 464–466. [Link]
45.
Jairath V, et al. Surgery or embolisation after failed endoscopic therapy. Br J Surg 2012; 99: 1672–1680. [Link]
46.
Chen WC, et al. Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome. BioMed Res Int 2014; 2014: 463767. [Link]
47.
Blacker DJ, Wijdicks EFM and McClelland RL. Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy. Neurology 2003; 61: 964–968. [Link]
48.
Sung JJY, et al. Continuation of low dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1–9. [Link]
49.
Beving H, et al. Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul Fibrinolysis 1996; 7: 80–84. [Link]
50.
Fatah K, et al. Acetylsalicylic acid may protect the patient by increasing fibrin gel porosity. Is withdrawing of treatment harmful to the patient? Eur Heart J 1996; 17: 1362–1366. [Link]
51.
Vial JH, McLeod LJ and Roberts MS. Rebound elevation in urinary thromboxane B2 and 6-keto-PGF1 alpha excretion after aspirin withdrawal. Adv Prostaglandin Thromboxane Leukot Res 1991; 21A: 157–160. [Link]
52.
Barkun AN, et al. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses. Gastrointest Endosc 2009; 69: 786–799.
53.
Jensen DM, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002; 123: 407–413. [Link]
54.
Laine L, Stein C and Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc 1996; 43: 107–110. [Link]
55.
Sung JJ, et al. The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison. Ann Intern Med 2003; 139: 237–243. [Link]
56.
Kahi CJ, et al. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 2005; 129: 855–862. [Link]
57.
Laine L and McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009; 7: 33–47. [Link]
58.
Sung JJ, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011; 43: 291–295.

Abstract

Upper and lower gastrointestinal endoscopy examinations are performed daily as routine diagnostic procedures in a large number of patients with nonspecific indications, such as heartburn, pain, anaemia, bleeding, workup of portal hypertension and so on. Most of the examinations will point to a classic diagnosis (e.g. peptic disease, cancer, variceal management), but sometimes we see patients who've had multiple diagnostic endoscopic procedures in the previous few months with nonconclusive findings. The diagnostic mistakes discussed here are those that sprang to mind based on our endoscopic experience and they are discussed in an evidence-based approach. For therapeutic endoscopic procedures (e.g. ERCP and resections), we present the most important mistakes that are often seen in our practice and have major consequences for the patient. We propose, from our experience, a simple approach to avoid these mistakes.

Topics

Endoscopy

Published

2024

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Manmeet Matharoo Manmeet Matharoo, Siwan Thomas-Gibson, Srivathsan Ravindran

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European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma Abdulbaqi Al-Toma

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in colonoscopy and how to avoid them

Manmeet Matharoo, Siwan Thomas-Gibson, Srivathsan Ravindran

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Targownik LE and Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993–2003. Clin Gastroenterol Hepatol 2006; 4: 1459–1466. [Link]
2.
Zhao Y and Encinosa W. Hospitalizations for gastrointestinal bleeding in 1998 and 2006. HCUP Statistical Brief #65. December, 2008. Agency for Healthcare Research and Quality, Rockville, MD. [Link]
3.
van Leerdam ME, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 2003; 98: 1494–1499. [Link]
4.
St. Elsewhere’s NHS Trust. UK comparative audit of upper gastrointestinal bleeding and the use of blood December 2007. [Link]
5.
Mohammed N, et al. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience. Endosc Int Open 2016; 4: E282–E286. [Link]
6.
Hearnshaw SA, et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327–1335. [Link]
7.
Barkun A, et al; RUGBE Investigators. The Canadian registry on nonvariceal upper gastrointestinal bleeding and endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004; 99: 1238–1246. [Link]
8.
Cipolletta L, et al. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 2002; 55: 1–5. [Link]
9.
Spiegel BM, Vakil NB and Ofman JJ. Endoscopy for acute nonvariceal upper gastrointestinal tract hemorrhage: is sooner better? A systematic review. Arch Intern Med 2001; 161: 1393–1404. [Link]
10.
Hay JA, et al. Prospective evaluation of a clinical guideline recommending hospital length of stay in upper gastrointestinal tract hemorrhage. JAMA 1997; 278: 2151–2156. [Link]
11.
Lin HJ, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol 1996; 22: 267–271. [Link]
12.
Lee JG, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc 1999; 50: 755–761. [Link]
13.
Bjorkman DJ, et al. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc 2004; 60: 1–8. [Link]
14.
Blatchford O, Murray WR and Blatchford M. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000; 356: 1318–1321. [Link]
15.
Steg PG, et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS ONE 2012; 7: e36284. [Link]
16.
Daly CA, et al. Inadequate control of heart rate in patients with stable angina: results from the European heart survey. Postgrad Med J 2010; 86: 212–217. [Link]
17.
Stanley AJ, et al. Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation. Lancet 2009; 373: 42–47. [Link]
18.
Rockall TA, et al. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316–321. [Link]
19.
National Institute for Health and Clinical Excellence. Clinical Guideline 141: Acute upper gastrointestinal bleeding: management. 2012. [Link]
20.
Baradarian R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastro 2004; 99: 619–622. [Link]
21.
Marik PE and Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667–2674. [Link]
22.
Kim P, et al. Impact of acute blood loss anemia and red blood cell transfusion on mortality after percutaneous coronary intervention. Clin Cardiol 2007; 30: II-35–ll-43. [Link]
23.
Blair SD, et al. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986; 73: 783–785. [Link]
24.
Fortune JB, et al. Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 1987; 27: 243–249. [Link]
25.
Casutt M, et al. Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med 1999; 27: 2194–2200. [Link]
26.
Dietrich KA, et al. Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990; 18: 940–944. [Link]
27.
Tsai AG, Cabrales P and Intaglietta M. Microvascular perfusion upon exchange transfusion with stored red blood cells in normovolemic anemic conditions. Transfusion 2004; 44: 1626–1234. [Link]
28.
Koch CG, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358: 1229–1239. [Link]
29.
Oliveira RP, et al. Clinical review: hypertonic saline resuscitation in sepsis. Crit Care 2002; 6: 418–423. [Link]
30.
American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med 2004; 170: 1247–1259. [Link]
31.
Perel P, Roberts I and Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013; 2: CD000567. [Link]
32.
Zarychanski R, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA. 2013; 309: 678–688. [Link]
33.
Annane S, et.al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock. The CRISTAL randomized trial. JAMA 2013; 310: 1809–1817. [Link]
34.
Perel P and Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. In The Cochrane Library, 2007, Issue 4. London: John Wiley & Sons Ltd.
35.
SIGN. Guideline 105. Management of acute upper and lower gastrointestinal bleeding. September 2008. [Link]
36.
Gralnek IM, et.al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1–a46. [Link]
37.
Kwan I, et al. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2014; 3: CD002245. [Link]
38.
Villanueva C, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368: 11–21. [Link]
39.
Jairath V et.al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015; 386: 137–144. [Link]
40.
American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105: 198–208. [Link]
41.
Carson JL, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J 2013; 165: 964–71.e1.
42.
Rubin A, Murdoch M and Nelson DB, Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest Endosc 2003; 58: 369–373. [Link]
43.
Holster IL, et al. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 2013; 145: 105–112. [Link]
44.
Choudari CP, Rajgopal C and Palmer KR. Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment. Gut 1994; 35: 464–466. [Link]
45.
Jairath V, et al. Surgery or embolisation after failed endoscopic therapy. Br J Surg 2012; 99: 1672–1680. [Link]
46.
Chen WC, et al. Gastrointestinal hemorrhage in warfarin anticoagulated patients: incidence, risk factor, management, and outcome. BioMed Res Int 2014; 2014: 463767. [Link]
47.
Blacker DJ, Wijdicks EFM and McClelland RL. Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy. Neurology 2003; 61: 964–968. [Link]
48.
Sung JJY, et al. Continuation of low dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1–9. [Link]
49.
Beving H, et al. Abnormally high platelet activity after discontinuation of acetylsalicylic acid treatment. Blood Coagul Fibrinolysis 1996; 7: 80–84. [Link]
50.
Fatah K, et al. Acetylsalicylic acid may protect the patient by increasing fibrin gel porosity. Is withdrawing of treatment harmful to the patient? Eur Heart J 1996; 17: 1362–1366. [Link]
51.
Vial JH, McLeod LJ and Roberts MS. Rebound elevation in urinary thromboxane B2 and 6-keto-PGF1 alpha excretion after aspirin withdrawal. Adv Prostaglandin Thromboxane Leukot Res 1991; 21A: 157–160. [Link]
52.
Barkun AN, et al. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: a series of meta-analyses. Gastrointest Endosc 2009; 69: 786–799.
53.
Jensen DM, et al. Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots. Gastroenterology 2002; 123: 407–413. [Link]
54.
Laine L, Stein C and Sharma V. A prospective outcome study of patients with clot in an ulcer and the effect of irrigation. Gastrointest Endosc 1996; 43: 107–110. [Link]
55.
Sung JJ, et al. The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison. Ann Intern Med 2003; 139: 237–243. [Link]
56.
Kahi CJ, et al. Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology 2005; 129: 855–862. [Link]
57.
Laine L and McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol 2009; 7: 33–47. [Link]
58.
Sung JJ, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011; 43: 291–295.

Abstract

Colonoscopy is a complex procedure requiring both technical and non-technical skills. Performing colonoscopy also requires manual and visuospatial skills, interpretation of pathology, patient communication and a wide range of advanced therapeutic technologies. The clinical intention of colonoscopy must be individualised, and diagnostic and/or therapeutic intent rationalised, given the procedures invasive nature and associated risks. Furthermore, each colonoscopy differs due to patient factors, sedation strategy, anatomical configuration, technical challenges and endoscopist skills. Endoscopists must, therefore, demonstrate a wide range of expertise whilst working effectively in a team to manage the patient safely. It is not, therefore, surprising that mistakes in colonoscopy can occur. This article focuses on six common mistakes in colonoscopy that can be avoided to improve the procedure's safety and deliver a high-quality procedure. This, in turn, can reduce the rates of post-colonoscopy colorectal cancer (PCCRC) and improve patient experience and adherence to colonoscopy surveillance programmes. This article is based on evidence in conjunction with our collective clinical and research experience of errors in endoscopy and patient safety.

Topics

Endoscopy

Citation

Matharoo M, Ravindran S and Thomas-Gibson S. Mistakes in colonoscopy and how to avoid them. UEG Education 2023; 23: 4-7.

Published

2023

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Abdulbaqi Al-Toma Abdulbaqi Al-Toma

UEG Podcast Episode
UEG Podcast
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Ten commandments of the colon

Egle Dieninyte - Misiune 1, Cesare Hassan 2

Affiliations

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Humanitas University, Rome, Italy

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Endoscopy

Published

2024

More Like This:

Malignancy in IBD with Hannah Gordon

Malignancy in IBD with Hannah Gordon

Pradeep Mundre Pradeep Mundre, Hannah Gordon

Mistakes in newly diagnosed Crohn's disease and how to avoid them

Mistakes in newly diagnosed Crohn's disease and how to avoid them

Nurulamin Noor Nurulamin Noor, Joana Roseira

Mistakes in endoscopy and how to avoid them

Mistakes in endoscopy and how to avoid them

Jacques Deviere Jacques Deviere, Arnaud Lemmers

Mistakes in colonoscopy and how to avoid them

Mistakes in colonoscopy and how to avoid them

Manmeet Matharoo Manmeet Matharoo, Siwan Thomas-Gibson, Srivathsan Ravindran

Ten commandments of the colon

Ten commandments of the colon

Cesare Hassan Cesare Hassan, Egle Dieninyte - Misiune

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma Abdulbaqi Al-Toma

UEG Standards and Guidelines
Clinical Practice Guideline
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma

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Guideline

ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, significant advancements have emerged in the diagnosis of coeliac disease (CeD) in adults. These 2025 guidelines incorporate new evidence to refine diagnostic strategies, aiming for improved accuracy of testing, and enhance overall quality of clinical care.

Methods

A multidisciplinary panel of experts revised the ESsCD guidelines using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) and the GRADE methodology (The Grading of Recommendations Assessment, Development, and Evaluation). Clinical questions were structured using the PICO format, and statements and recommendations were finalised through a Delphi consensus process. Literature quality was assessed using AMSTAR-2 and QUADAS-2 tools.

Results

The updated guidelines are presented in two parts. Part 1 focuses on adult CeD diagnosis, introducing major changes such as a conditional no-biopsy approach for selected adults with high-titre IgA anti-TG2 serology (≥ 10 × ULN). Regarding serology, the use of validated high-performance ELISAs displaying a high diagnostic accuracy is emphasised, while routine use of IgA anti-Endomysium serology is no longer recommended for confirmation. Revised duodenal biopsy protocols now mandate at least four samples from the second part of the duodenum, with bulb biopsies conditionally included. The guidelines provide structured approaches for diagnosing potential CeD, seronegative villous atrophy, and CeD in individuals already on a gluten-free diet. HLA-DQ2/DQ8 typing is recommended for diagnostic clarification in select cases.

Conclusions

The updated 2025 ESsCD guidelines provide a comprehensive framework for the diagnosis of CeD in adults. By integrating evolving diagnostic strategies, minimising over-testing, and patient-centred care approaches, they aim to optimise patient outcomes, quality of life and use of diagnostic resources at the same time.

Guideline

Clinical Practice Guideline

Topics

Small Intestine & Nutrition

Citation

United European Gastroenterology Journal; 2025; 00:1–32

Published

2025

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European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma Abdulbaqi Al-Toma

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