GI Bleeding

Gastrointestinal bleeding is one of the highest-volume indications for emergent endoscopy. The clinical priorities are resuscitation, source identification, and durable hemostasis. Bleeding is broadly classified by anatomic location: upper GI bleeding originates proximal to the ligament of Treitz (typically from peptic ulcers, esophageal or gastric varices, Mallory-Weiss tears, Dieulafoy lesions, and angiodysplasias), middle GI from the small bowel (often vascular lesions and tumors), and lower GI from the colon (diverticular disease, angiodysplasia, ischemic and inflammatory colitis, hemorrhoids, post-polypectomy bleeding).

Endoscopic hemostasis combines mechanical, thermal, and injection techniques. Through-the-scope and over-the-scope clips, band ligation, gold probe and bipolar coagulation, argon plasma coagulation, and dilute epinephrine injection are the workhorse tools. The Forrest classification guides treatment of peptic ulcer bleeding, and combination therapy (injection plus a second modality) outperforms monotherapy for high-risk lesions.

The articles below cover specific scenarios — from clipping a Mallory-Weiss tear to managing massive duodenal ulcer bleeding with the over-the-scope clip — with case-based pearls and step-by-step technique.