Management of acute UGIB. Key priority recommendations from NICE clinical guidelines (CG141). Reproduced with permission.2
| Risk assessment |
| 1. Use the following formal risk assessment scores for all patients with UGIB: |
| > Blatchford score at first assessment |
| > full Rockall score after endoscopy. |
| Timing of endoscopy |
| 1. Offer endoscopy to unstable patients with severe UGIB immediately after resuscitation. |
| 2. Offer endoscopy within 24 hours of admission to all other patients with UGIB. |
| 3. Units seeing >330 cases a year should offer daily endoscopy lists. Units seeing <330 cases a year should arrange their service according to local circumstances. |
| Management of non-variceal bleeding |
| 1. Do not use adrenaline as monotherapy for the endoscopic treatment of non-variceal UGIB. |
| 2. For the endoscopic treatment of non-variceal UGIB, use one of the following: |
| > a mechanical method (for example, clips) with or without adrenaline |
| > thermal coagulation with adrenaline |
| > fibrin or thrombin with adrenaline. |
| 3. Offer interventional radiology to unstable patients who re-bleed after endoscopic treatment. Refer urgently for surgery if interventional radiology is not promptly available. |
| Management of variceal bleeding |
| 1. Offer prophylactic antibiotic therapy at presentation to patients with suspected or confirmed variceal bleeding. |
| 2. Consider TIPS if bleeding from oesophageal varices is not controlled by band ligation. |
| Control of bleeding and prevention of re-bleeding in patients on NSAIDs, aspirin or clopidogrel |
| 1. Continue low-dose aspirin for secondary prevention of vascular events in patients with UGIB in whom haemostasis has been achieved. |
| NICE = National Institute for Health and Care Excellence; NSAIDs = non-steroidal anti-inflammatory drugs; TIPS = transjugular intrahepatic portosystemic shunts; UGIB = upper gastrointestinal bleeding. |