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A 56 y/o heavy alcohol user male presents with vomiting blood for several hours. BP=90/60, PR=110, RR=16, and T=98°F. Placement of an NGT shows active bright red bleeding. Which of the following is the treatment of choice?
(A) Tamponade with a Sengstaken-Blakemore tube
(B) Therapeutic upper GI endoscopy
© Octreotide infusion
(D) Vasopressin infusion
(E) Immediate referral for surgical intervention
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ANSWER:-
(B) Therapeutic upper GI endoscopy
GI bleeding is a common problem seen in the Esophageal diseases and is potentially life threatening. For patients with significant active bleeding, emergency endoscopy is the treatment of choice. Esophageal varices can be treated endoscopically with either band ligation or sclerotherapy, resulting in control of acute bleeding in up to 90 percent of patients. Hemostasis can be achieved with nonvariceal sources of bleeding as well. Drug therapy with both octreotide and somatostatin reduces bleeding from both varices and PUD and is a useful adjunct to endoscopy. Vasopressin therapy has largely been discontinued due to a high rate of adverse effects including hypertension, arrhythmias, myocardial ischemia, and decreased cardiac output. Balloon tamponade can be used as a temporizing measure to control bleeding by placing direct pressure on the gastric and esophageal mucosa. However, it is frequently associated with complications, including mucosal ulceration, esophageal or gastric rupture, asphyxiation from dislodged balloons, and aspiration pneumonia. Although it is appropriate to make a surgeon aware of a critical patient, emergency surgical intervention is indicated only in those patients who fail endoscopic hemostasis and medical therapy.
