Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 68-83
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.68
Role of endoscopy in acute gastrointestinal bleeding in real clinical practice: An evidence-based review
Kyoungwon Jung, Won Moon
Kyoungwon Jung, Won Moon, Department of Internal Medicine, Kosin University College of Medicine, Busan 49267, South Korea
Author contributions: Moon W substantially contributed to the conception and design of the review; Jung K contributed to the acquisition of data and drafting the article.
Conflict-of-interest statement: The authors declare that they have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Won Moon, MD, PhD, Professor, Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, South Korea.
Telephone: +82-51-9906103 Fax: +82-51-9905055
Received: December 17, 2018
Peer-review started: December 17, 2018
First decision: January 6, 2019
Revised: February 2, 2019
Accepted: February 13, 2019
Article in press: February 13, 2019
Published online: February 16, 2019

Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.

Keywords: Endoscopy, Gastrointestinal bleeding, Endoscopic bleeding control, Emergency bowel preparation, Bedside endoscopy, Second-look endoscopy

Core tip: When a patient with signs of bleeding, such as hematemesis, melena, and hematochezia, presents to the emergency room, an endoscopic approach is considered together with initial resuscitation. Timely endoscopy and appropriate bowel preparation are very important in patients with acute gastrointestinal bleeding. In addition, mechanical bleeding control is an imperative part of therapeutic endoscopy. After bleeding control, the risk classification of rebleeding is important because old age, concomitant diseases, and use of drugs (non-steroidal anti-inflammatory drug, antiplatelet, and anticoagulant drugs) are increasing. Therefore, endoscopy has a very important role in the diagnosis, therapy, and prognosis of gastrointestinal bleeding.