Gastrointestinal Bleeding Symposium

[{"id":"278","chapterid":"9589","timeTo":"59.973 ","timeFrom":"0 ","number":"1","chaptername":"Introduction ","description":"The chapter introduces a gastrointestinal bleeding symposium featuring a live case and several lectures. Dr. Anderson from the UK and Professor Lo Baton, who is in the live endoscopy room, provide guidance. The first case involves Dr. David Tate addressing the approach to patients with suspected upper GI bleeding. This chapter sets the stage for the endoscopy session, emphasizing the collaborative effort and expertise involved in managing gastrointestinal bleeding cases. "},{"id":"278","chapterid":"9590","timeTo":"189.315 ","timeFrom":"59.974 ","number":"2","chaptername":"Live Session approach to upper GI bleeding ","description":"Chapter focuses on the endoscopic assessment of a 44-year-old female patient with decompensated liver cirrhosis and recurrent melena. It highlights the presence of a large pulsating fundal varix and portal hypertension indicators. The discussion includes reviewing ESG guidelines for non-variceal upper GI bleeding management. Detailed observations are made about the snake skin appearance indicative of portal hypertension, while confirming the absence of esophageal varices or additional lesions. The interplay between hepatologists and endoscopists is underscored in diagnosing upper GI conditions. "},{"id":"278","chapterid":"9591","timeTo":"201.57 ","timeFrom":"189.316 ","number":"3","chaptername":"Inspection of the esophagus ","description":"In this chapter, the condition of a varix is assessed as it flattens significantly upon inflation. The dialog implies a discussion about the degree of variceal flattening, potentially influencing the approach to management or further intervention. This insight is crucial for endoscopists who need to assess variceal changes during procedures accurately. "},{"id":"278","chapterid":"9592","timeTo":"367.742 ","timeFrom":"201.571 ","number":"4","chaptername":"Fundic varix ","description":"In this chapter, the repeated gastrointestinal bleeding in a patient is explored through a discussion on a suspected gastric varix. The chapter outlines the challenges of identifying the varix, illustrated with visual inspection during endoscopy. Potential treatment options, including the consideration of TIPS (Transjugular Intrahepatic Portosystemic Shunt) for patients with portal hypertension and advanced liver disease, are analyzed. The importance of timely intervention to prevent further bleeding is emphasized. Local treatment is suggested prior to a comprehensive patient evaluation. "},{"id":"278","chapterid":"9593","timeTo":"458.461 ","timeFrom":"367.743 ","number":"5","chaptername":"Nurse explanation of the use of HistoAcryl ","description":"In this chapter, the process of preparing and using histoacryl glue in endoscopic procedures is demonstrated. Emphasis is placed on the preparation steps, highlighting the importance of flushing the needle with lipid to prevent solidification before entering the varis. The technique showcases the collaboration among medical professionals to ensure successful glue injection, which is crucial in treating gastric conditions. Additionally, reference to supplementary nursing resources is made for further learning. "},{"id":"278","chapterid":"9594","timeTo":"767.949 ","timeFrom":"458.462 ","number":"6","chaptername":"Histoacryl glue injection of a gastric varix ","description":"In this chapter, the technique of injecting a varix with histo-acryl glue is demonstrated. Emphasis is placed on maintaining stable scope position, effective team communication, and ensuring the needle stays within the varix during the procedure. The process involves flushing the needle with lipid and histo-acryl, managing the aspiration, and carefully removing the needle to prevent mucosal damage. The chapter concludes with a demonstration of the glue's function in securing hemostasis within a gastric varix."},{"id":"278","chapterid":"9595","timeTo":"962.957 ","timeFrom":"767.949999","number":"7","chaptername":"Discussion of the live case ","description":"The chapter discusses the utility of endoscopic ultrasound (EUS) in treating gastric varices. It is highlighted that while a single histoacryl injection often suffices, EUS monitoring can help assess variceal flow and treatment completeness. Challenges in acute bleeding cases and the importance of communication among the medical team are emphasized. The procedure's complexity requires specialized training, with EUS directed therapy playing a crucial role in precise vessel targeting, especially in clean cases without excessive bleeding."},{"id":"278","chapterid":"9596","timeTo":"1614.956 ","timeFrom":"962.958 ","number":"8","chaptername":"Presentation on Non-Variceal Upper GI bleeding by Lobke Desomer ","description":"The chapter outlines the comprehensive approach to managing non-variceal upper GI bleeding, following the 2015 ESGE guidelines. Key topics include patient hemodynamic assessment, use of restrictive transfusion strategies, and endoscopic intervention methodologies. Various scoring systems like the Glasgow-Blatchford and Rockall scores are discussed for risk assessment. Practical insights on utilizing forest classifications for peptic ulcers and therapies such as adrenaline injection and clips are provided. The chapter emphasizes post-endoscopy care, focusing on PPI use and anticoagulant management, with a strong recommendation for documentation and potential surgical consultations for high-risk cases."},{"id":"278","chapterid":"9597","timeTo":"1765.39 ","timeFrom":"1614.95699","number":"9","chaptername":"Discussion ","description":"In this chapter, the strategy for removing clots during endoscopic procedures is discussed. It is emphasized that clots should be removed for effective targeting of the bleeding vessel, but timing is crucial. The recommendation is to wait up to 12 hours when possible and to assess patient stability, particularly in overnight situations. The risks associated with immediate clot removal versus waiting are considered, with emphasis on patient outcomes and visualization of the bleeding source."},{"id":"278","chapterid":"9598","timeTo":"2385.156 ","timeFrom":"1765.391 ","number":"10","chaptername":"Presentation on Approach to Variceal upper GI bleeding by Hans Van Vlierberghe ","description":"The chapter details the approach to variceal upper gastrointestinal bleeding, emphasizing it as a medical emergency with high complication and mortality rates. It covers the importance of intensive care, endoscopic and non-endoscopic treatments, the use of vasoactive drugs, antibiotic prophylaxis, and the role of liver disease severity. Also discussed are timing strategies for endoscopy and follow-up procedures, with insights into quality indicators and the relevance of secondary measures like the use of beta blockers."},{"id":"278","chapterid":"9599","timeTo":"2552.021 ","timeFrom":"2385.157 ","number":"11","chaptername":"Discussion ","description":"This chapter discusses the management of patients with suspected variceal bleeding, emphasizing the administration of vasoactive medications prior to endoscopy. It covers the use of vasoconstrictors for five days irrespective of the vasoconstrictor chosen and considerations in patients with potential cirrhosis. Additionally, the initiation of non-selective beta blockers following vasoconstrictor administration is highlighted, while noting alternative approaches for patients with specific comorbidities."},{"id":"278","chapterid":"9600","timeTo":"3412.184 ","timeFrom":"2552.02200","number":"12","chaptername":"Approach to lower GI bleeding by Danny De Looze ","description":"The chapter discusses the approach to acute lower GI bleeding, emphasizing the need for CT angiography in unstable patients to determine bleeding sources. It highlights diverticular bleeding as a common cause and compares treatment methods like coagulation, clipping, and ligation. The importance of bowel preparation and the use of evaluation tools such as risk assessment scores are noted. Recommendations include waiting 24 hours before performing a colonoscopy for thorough preparation and team availability."},{"id":"278","chapterid":"9601","timeTo":" ","timeFrom":"3412.18500","number":"13","chaptername":"Discussion ","description":"Chapter focuses on the visual assessment of the angulus and fundus during an endoscopy procedure. Attention is drawn to the 'snake skin' appearance of the area, emphasizing the importance of careful inspection. The discussion briefly addresses the reduction of air for improved visibility, highlighting techniques for optimal visualization in the upper gastrointestinal tract."},{"id":"278","chapterid":"9602","timeTo":"177.99","timeFrom":"146","number":"14","chaptername":"Snake Skin aspect","description":"In this chapter, a detailed examination of the distal esophagus is conducted, identifying a solitary varix. Despite its presence, it is discussed that the flattened varix may not be the cause of the patient's recurring bleeding. After ruling out other potential sources through a comprehensive colonoscopy and abdominal imaging, the discussion shifts to determining the ongoing source of bleeding."},{"id":"278","chapterid":"9603","timeTo":"229.99","timeFrom":"178","number":"15","chaptername":"Oesophageal Varices","description":"In this chapter, the identification and treatment of a gastric varix are discussed. The importance of assessing liver function and the potential use of TIPS in advanced liver disease are highlighted. A detailed procedure involving the delivery system for histoacryl glue is demonstrated, emphasizing the preparation and stable scope position required for successful varix injection. Communication among the medical team is stressed for effective treatment outcomes."},{"id":"278","chapterid":"9604","timeTo":"527.99","timeFrom":"230","number":"16","chaptername":"Gastric Varix","description":"This chapter discusses the approach, management, and procedural techniques for gastrointestinal bleeding, focusing on endoscopy practices. It provides insights into diagnosing bleeding sources, elective timing of interventions, and specific techniques for treating various types of upper and lower GI bleeding, including variceal and non-variceal scenarios. Case studies are used to illustrate best practices, and the importance of inter-professional communication and collaboration is emphasized."},{"id":"278","chapterid":"9605","timeTo":null,"timeFrom":"528","number":"17","chaptername":"Injection of Histoacryl glue","description":"The chapter demonstrates a focused examination of the gastric fundus and angulus, highlighting the visual clarity of the 'snake skin' pattern, and preparing for potential intervention. Air withdrawal is executed, enhancing visualization and assessment of the gastric landmarks. The chapter's discourse momentarily shifts towards addressing a query related to these visual techniques, emphasizing the importance of identifying specific features during an endoscopy for both diagnostic and procedural purposes."},{"id":"278","chapterid":"9606","timeTo":"177.99","timeFrom":"146","number":"18","chaptername":"Snake Skin aspect","description":"In this chapter, the endoscopic assessment of the distal esophagus is demonstrated, focusing on identification of potential bleeding sources. Despite the presence of varices, these are unlikely to be the cause of repeated bleeding due to flattening under inflation. Comprehensive diagnostics including colonoscopy and abdominal imaging have not revealed an alternative source. The chapter emphasizes the importance of thorough examination when determining causes of gastrointestinal bleeding."},{"id":"278","chapterid":"9607","timeTo":"229.99","timeFrom":"178","number":"19","chaptername":"Oesophageal Varices","description":"In this chapter, a detailed discussion of the identification and management of gastric varices is undertaken. The technique involving the use of histo-acryl glue is demonstrated, emphasizing the importance of having a stable scope position and effective communication with assistants during the procedure. Consideration is also given to options like TIPS, taking into account liver function and availability. The chapter underscores the critical nature of rehearsing each step before performing the intervention to minimize risks."}]

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Dr. Anderson from the UK and Professor Lo Baton, who is in the live endoscopy room, provide guidance. The first case involves Dr. David Tate addressing the approach to patients with suspected upper GI bleeding. This chapter sets the stage for the endoscopy session, emphasizing the collaborative effort and expertise involved in managing gastrointestinal bleeding cases. ","tagid":"257","tagName":"Endoscopic Video and Room Video with Audio"},{"id":"278","split":"1","chapterid":"9590","timeFrom":"59.974 ","timeTo":"189.315 ","number":"2","chaptername":"Live Session approach to upper GI bleeding ","description":"Chapter focuses on the endoscopic assessment of a 44-year-old female patient with decompensated liver cirrhosis and recurrent melena. It highlights the presence of a large pulsating fundal varix and portal hypertension indicators. The discussion includes reviewing ESG guidelines for non-variceal upper GI bleeding management. 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Potential treatment options, including the consideration of TIPS (Transjugular Intrahepatic Portosystemic Shunt) for patients with portal hypertension and advanced liver disease, are analyzed. The importance of timely intervention to prevent further bleeding is emphasized. Local treatment is suggested prior to a comprehensive patient evaluation. ","tagid":"351","tagName":"Determining the source of bleeding"},{"id":"278","split":"1","chapterid":"9592","timeFrom":"201.571 ","timeTo":"367.742 ","number":"4","chaptername":"Fundic varix ","description":"In this chapter, the repeated gastrointestinal bleeding in a patient is explored through a discussion on a suspected gastric varix. The chapter outlines the challenges of identifying the varix, illustrated with visual inspection during endoscopy. Potential treatment options, including the consideration of TIPS (Transjugular Intrahepatic Portosystemic Shunt) for patients with portal hypertension and advanced liver disease, are analyzed. 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","tagid":"708","tagName":"Portal hypertensive gastropathy"},{"id":"278","split":"1","chapterid":"9593","timeFrom":"367.743 ","timeTo":"458.461 ","number":"5","chaptername":"Nurse explanation of the use of HistoAcryl ","description":"In this chapter, the process of preparing and using histoacryl glue in endoscopic procedures is demonstrated. Emphasis is placed on the preparation steps, highlighting the importance of flushing the needle with lipid to prevent solidification before entering the varis. The technique showcases the collaboration among medical professionals to ensure successful glue injection, which is crucial in treating gastric conditions. Additionally, reference to supplementary nursing resources is made for further learning. ","tagid":"416","tagName":"Histoacryl glue"}]