Endoscopic management of upper non-variceal and lower gastrointestinal bleeding: Where do we stand?

Table 1 Endoscopic management of gastrointestinal bleeding

Category	UGIB	LGIB
Risk stratification	Use GBS for pre-endoscopy assessment. GBS ≤ 1: Safe outpatient management. GBS ≥ 7: High risk, requires intervention	Use risk scores like Oakland Score to determine the need for hospitalization and intervention
Timing of endoscopy	Early endoscopy (≤ 24 hours) recommended after resuscitation. Urgent endoscopy (≤ 12 hours) only in hemodynamically unstable patients	Colonoscopy within 24 hours for hemodynamically stable patients. Urgent colonoscopy in massive bleeding with ongoing instability
Initial hemostasis	Combination therapy for active bleeding ulcers (e.g., epinephrine + thermal/mechanical therapy). Nonbleeding visible vessels (FIIa) treated with thermal, mechanical, or sclerosing agents	Endoscopic therapy for visible bleeding sources (e.g., clips, coagulation, injection therapy)
Persistent or recurrent bleeding	Second endoscopic hemostasis attempt if initial therapy fails. Consider transcatheter arterial embolization or surgery if endoscopic treatment fails	Repeat endoscopic therapy for ongoing bleeding. If unsuccessful, angiography with embolization or surgery may be needed
Pharmacologic management	High-dose PPIs post-endoscopy (e.g., continuous infusion or alternative regimens)	No routine use of PPIs; focus on treating underlying cause (e.g., anticoagulant reversal if applicable)
Anticoagulation management	Resume anticoagulation within 7 days of controlled bleeding, balancing thrombotic risk	Resume anticoagulation based on bleeding severity and thrombotic risk assessment
Special considerations	Consider hemostatic sprays or cap-mounted clips for challenging cases	For diverticular bleeding or angiodysplasia, thermal therapy or endoscopic clips may be used

UGIB: Upper gastrointestinal bleeding; LGIB: Lower gastrointestinal bleeding; GBS: Glasgow-Blatchford Score; PPI: Proton pump inhibitor.