Advances in endoscopic treatment timing for acute non⁃variceal upper gastrointestinal bleeding

TAO Yingying; ZHENG Hui; YANG Jianfeng

doi:10.14188/j.1671-8852.2024.0100

您当前的位置：

首页 >

文章列表页 >

Advances in endoscopic treatment timing for acute non⁃variceal upper gastrointestinal bleeding

更新时间：2026-11-05

- Advances in endoscopic treatment timing for acute non⁃variceal upper gastrointestinal bleeding
- Medical Journal of Wuhan University Vol. 46, Issue 9, Pages: 1218-1223(2025)
- 作者机构：
  
  1.浙江中医药大学浙江杭州 310000
  2.杭州市第九人民医院急诊科浙江杭州 310000
  3.西湖大学医学院附属杭州市第一人民医院消化内科浙江杭州 310000
- 作者简介：
- 基金信息：
- DOI：10.14188/j.1671-8852.2024.0100
  CLC： R573.2
- Received：08 February 2024，
  
  Published：26 September 2025
- 稿件说明：
移动端阅览
陶莹莹,郑晖,杨建锋.急性非静脉曲张性上消化道出血内镜治疗时机的研究进展[J].武汉大学学报（医学版）,2025,46(09):1218-1223.

TAO Yingying,ZHENG Hui,YANG Jianfeng.Advances in endoscopic treatment timing for acute non⁃variceal upper gastrointestinal bleeding[J].Medical Journal of Wuhan University,2025,46(09):1218-1223.
陶莹莹,郑晖,杨建锋.急性非静脉曲张性上消化道出血内镜治疗时机的研究进展[J].武汉大学学报（医学版）,2025,46(09):1218-1223. DOI： 10.14188/j.1671-8852.2024.0100.

TAO Yingying,ZHENG Hui,YANG Jianfeng.Advances in endoscopic treatment timing for acute non⁃variceal upper gastrointestinal bleeding[J].Medical Journal of Wuhan University,2025,46(09):1218-1223. DOI： 10.14188/j.1671-8852.2024.0100.

摘要

急性非静脉曲张性上消化道出血（ANVUGIB）作为一种常见的危急重症，在临床治疗中显得尤为重要。内镜检查作为有效的直接观察和止血治疗手段，不仅有助于明确出血原因，而且提供及时干预，已成为处理此类出血的首选措施。针对内镜检查的前期评估有助于医生作出迅速而精准的治疗决策。内镜治疗的时机对患者的预后有着至关重要的影响，而对于紧急内镜时机及其对患者预后的影响仍有待深入研究。本综述旨在探讨ANVUGIB的内镜前评估及治疗时机，特别是紧急内镜对临床结果的影响，同时提供实用指南并对未来研究方向提出建议。

Abstract

Acute non‑variceal upper gastrointestinal bleeding (ANVUGIB) is a common and critical condition in clinical practice. Endoscopic examination

serving as an effective method for direct observation and hemostatic treatment

not only helps in identifying the cause of bleeding but also provides timely intervention

making it the preferred approach for managing such hemorrhagic events. Pre‑endoscopic assessment enables physicians in making rapid and accurate treatment decisions. The timing of endoscopic treatment is crucial for patient prognosis

and further research is needed on the impact of emergency endoscopy timing on patient outcomes. This review aims to explore pre‑endoscopic evaluation and treatment timing for ANVUGIB

especially the impact of emergency endoscopy on clinical outcomes

providing practical guidelines and suggesting directions for future research.

关键词

Keywords

references

《中华内科杂志》编辑委员会 , 《中华医学杂志》编辑委员会 , 《中华消化杂志》编辑委员会 , 等 . 急性非静脉曲张性上消化道出血诊治指南(2018年, 杭州) [J ] . 中华内科杂志 , 2019 , 58 ( 3 ): 173 ‑ 180 .

Editorial Board of Chinese Journal of Internal Medicine , Editorial Board of National Medical Journal of China , Editorial Board of Chinese Journal of Digestion , et al . Guidelines for the diagnosis and treatment of acute non‑variceal upper gastrointestinal bleeding (2018, Hangzhou) [J ] . Chin J Intern Med , 2019 , 58 ( 3 ): 173 ‑ 180 .

王海燕 , 顿晓熠 , 柏愚 , 等 . 中国上消化道出血的临床流行病学分析 [J ] . 中华消化内镜杂志 , 2013 , 30 ( 2 ): 83 ‑ 86 .

WANG H Y , DUN X Y , BAI Y , et al . Clinical epidemiologic study of upper gastrointestinal bleeding in China [J ] . Chin J Dig Endosc , 2013 , 30 ( 2 ): 83 ‑ 86 .

JAIRATH V , MARTEL M , LOGAN R F A , et al . Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world? A systematic review of cohort studies [J ] . Can J Gastroenterol , 2012 , 26 ( 8 ): 537 ‑ 543 .

WUERTH B A , ROCKEY D C . Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: A nationwide analysis [J ] . Dig Dis Sci , 2018 , 63 ( 5 ): 1286 ‑ 1293 .

YANG E , CHANG M A , SAVIDES T J . New techniques to control gastrointestinal bleeding [J ] . Gastroenterol Hepatol , 2019 , 15 ( 9 ): 471 ‑ 479 .

刘星淇 , 王鹏阁 , 何松 , 等 . 急性非静脉曲张性上消化道出血治疗的研究进展 [J ] . 临床急诊杂志 , 2023 , 24 ( 10 ): 549 ‑ 554 .

LIU X Q , WANG P G , HE S , et al . Research progress in treatment of acute nonvariceal upper gastrointestinal bleeding [J ] . J Clin Emerg , 2023 , 24 ( 10 ): 549 ‑ 554 .

LAINE L , BARKUN A N , SALTZMAN J R , et al . ACG clinical guideline: Upper gastrointestinal and ulcer bleeding [J ] . Am J Gastroenterol , 2021 , 116 ( 5 ): 899 ‑ 917 .

中国医师协会急诊医师分会 , 中华医学会急诊医学分会 , 全军急救医学专业委员会 , 等 . 急性上消化道出血急诊诊治流程专家共识(2020版) [J ] . 中华急诊医学杂志 , 2021 , 30 ( 1 ): 15 ‑ 24 .

Chinese College of Emergency Physcians , Chinese Medical Association of Emergency , Military Emergency Medicine Professional Committee , et al . Expert consensus on emergency diagnosis and treatment of acute upper gastrointestinal hemorrhage (2020 edition) [J ] . Chinese Journal of Emergency Medicine , 2021 , 30 ( 1 ): 15 ‑ 24 .

GRALNEK I M , STANLEY A J , MORRIS A J , et al . Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline⁃Update 2021 [J ] . Endoscopy , 2021 , 53 ( 3 ): 300 ‑ 332 .

SUNG J J , CHIU P W , CHAN F K L , et al . Asia‑Pacific working group consensus on non‑variceal upper gastrointestinal bleeding: An update 2018 [J ] . Gut , 2018 , 67 ( 10 ): 1757 ‑ 1768 .

BLATCHFORD O , MURRAY W R , BLATCHFORD M . A risk score to predict need for treatment for upper‑gastrointestinal haemorrhage [J ] . Lancet , 2000 , 356 ( 9238 ): 1318 ‑ 1221 .

CHENG D W , LU Y W , TELLER T , et al . A modified Glasgow Blatchford Score improves risk stratification in upper gastrointestinal bleed: A prospective comparison of scoring systems [J ] . Aliment Pharmacol Ther , 2012 , 36 ( 8 ): 782 ‑ 789 .

SALTZMAN J R , TABAK Y P , HYETT B H , et al . A simple risk score accurately predicts in‑hospital mortality, length of stay, and cost in acute upper GI bleeding [J ] . Gastrointest Endosc , 2011 , 74 ( 6 ): 1215 ‑ 1224 .

THANDASSERY R B , SHARMA M , JOHN A K , et al . Clinical application of AIMS65 scores to predict outcomes in patients with upper gastrointestinal hemorrhage [J ] . Clin Endosc , 2015 , 48 ( 5 ): 380 ‑ 384 .

CHANG A , OUEJIARAPHANT C , AKARAPATIMA K , et al . Prospective comparison of the AIMS65 score, Glasgow‑Blatchford score, and Rockall score for predicting clinical outcomes in patients with variceal and nonvariceal upper gastrointestinal bleeding [J ] . Clin Endosc , 2021 , 54 ( 2 ): 211 ‑ 221 .

CHEN I C , HUNG M S , CHIU T F , et al . Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding [J ] . Am J Emerg Med , 2007 , 25 ( 7 ): 774 ‑ 779 .

PANG S H , CHING J Y L , LAU J Y W , et al . Comparing the Blatchford and pre‑endoscopic Rockall score in predicting the need for endoscopic therapy in patients with upper GI hemorrhage [J ] . Gastrointest Endosc , 2010 , 71 ( 7 ): 1134 ‑ 1140 .

STANLEY A J , ASHLEY D , DALTON H R , et al . Outpatient management of patients with low‑risk upper‑gastrointestinal haemorrhage: Multicentre validation and prospective evaluation [J ] . Lancet , 2009 , 373 ( 9657 ): 42 ‑ 47 .

STANLEY A J , LAINE L , DALTON H R , et al . Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: International multicentre prospective study [J ] . BMJ , 2017 , 356 : i6432 .

YAKA E , YILMAZ S , DOĞAN N Ö , et al . Comparison of the Glasgow‑Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department [J ] . Acad Emerg Med , 2015 , 22 ( 1 ): 22 ‑ 30 .

AHN D W , PARK Y S , LEE S H , et al . Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: The role of urgent endoscopy [J ] . Korean J Intern Med , 2016 , 31 ( 3 ): 470 ‑ 478 .

GARG S K , ANUGWOM C , CAMPBELL J , et al . Early esophagogastroduodenoscopy is associated with better outcomes in upper gastrointestinal bleeding: A nationwide study [J ] . Endosc Int Open , 2017 , 5 ( 5 ): E376 ‑ E386 .

JEONG N , KIM K S , JUNG Y S , et al . Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage [J ] . Am J Emerg Med , 2019 , 37 ( 2 ): 277 ‑ 280 .

SIAU K , HODSON J , INGRAM R , et al . Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee‑led audit [J ] . United European Gastroenterol J , 2019 , 7 ( 2 ): 199 ‑ 209 .

XIA X F , CHIU P W Y , TSOI K K F , et al . The effect of off‑hours hospital admission on mortality and clinical outcomes for patients with upper gastrointestinal hemorrhage: A systematic review and meta‑analysis of 20 cohorts [J ] . United European Gastroenterol J , 2018 , 6 ( 3 ): 367 ‑ 381 .

CHO S H , LEE Y S , KIM Y J , et al . Outcomes and role of urgent endoscopy in high‑risk patients with acute nonvariceal gastrointestinal bleeding [J ] . Clin Gastroenterol Hepatol , 2018 , 16 ( 3 ): 370 ‑ 377 .

ALEXANDRINO G , DOMINGUES T D , CARVALHO R , et al . Endoscopy timing in patients with acute upper gastrointestinal bleeding [J ] . Clin Endosc , 2019 , 52 ( 1 ): 47 ‑ 52 .

LAURSEN S B , LEONTIADIS G I , STANLEY A J , et al . Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: A nationwide cohort study [J ] . Gastrointest Endosc , 2017 , 85 ( 5 ): 936 ‑ 944.e3 .

LAU J Y W , YU Y Y , TANG R S Y , et al . Timing of endoscopy for acute upper gastrointestinal bleeding [J ] . N Engl J Med , 2020 , 382 ( 14 ): 1299 ‑ 1308 .

GUO C L T , WONG S H , LAU L H S , et al . Timing of endoscopy for acute upper gastrointestinal bleeding: A territory‑wide cohort study [J ] . Gut , 2022 , 71 ( 8 ): 1544 ‑ 1550 .

SALEEM S A , KUDARAVALLI P , RIAZ S , et al . Outcomes of upper gastrointestinal bleeding based on time to endoscopy: A retrospective study [J ] . Cureus , 2020 , 12 ( 3 ): e7325 .

KUMAR N L , TRAVIS A C , SALTZMAN J R . Initial management and timing of endoscopy in nonvariceal upper GI bleeding [J ] . Gastrointest Endosc , 2016 , 84 ( 1 ): 10 ‑ 17 .

杨修玲 , 蔡奉娟 , 王巧珍 , 等 . 内镜检查时机对急性非静脉曲张性上消化道出血患者临床结局的影响 [J ] . 临床急诊杂志 , 2023 , 24 ( 3 ): 149 ‑ 154 .

YANG X L , CAI F J , WANG Q Z , et al . Effect of timing of endoscopy on clinical outcomes in patients with acute nonvaricose upper gastrointestinal bleeding [J ] . J Clin Emerg , 2023 , 24 ( 3 ): 149 ‑ 154 .

LIM L G , HO K Y , CHAN Y H , et al . Urgent endoscopy is associated with lower mortality in high‑risk but not low‑risk nonvariceal upper gastrointestinal bleeding [J ] . Endoscopy , 2011 , 43 ( 4 ): 300 ‑ 306 .

TOKA B , EMINLER A T , KARACAER C , et al . Comparison of monopolar hemostatic forceps with soft coagulation versus hemoclip for peptic ulcer bleeding: A randomized trial (with video) [J ] . Gastrointest Endosc , 2019 , 89 ( 4 ): 792 ‑ 802 .

BARACAT F I , DE MOURA D T H , BRUNALDI V O , et al . Randomized controlled trial of hemostatic powder versus endoscopic clipping for non‑variceal upper gastrointestinal bleeding [J ] . Surg Endosc , 2020 , 34 ( 1 ): 317 ‑ 324 .

KWEK B E A , ANG T L , ONG P L J , et al . TC‑325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high‑risk bleeding stigmata: A randomized pilot study [J ] . J Dig Dis , 2017 , 18 ( 6 ): 323 ‑ 329 .

BAPAYE J , CHANDAN S , NAING L Y , et al . Safety and efficacy of over‑the‑scope clips versus standard therapy for high‑risk nonvariceal upper GI bleeding: Systematic review and meta‑analysis [J ] . Gastrointest Endosc , 2022 , 96 ( 5 ): 712 ‑ 720.e7 .

SHUNG D L , AU B , TAYLOR R A , et al . Validation of a machine learning model that outperforms clinical risk scoring systems for upper gastrointestinal bleeding [J ] . Gastroenterology , 2020 , 158 ( 1 ): 160 ‑ 167 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Application effect of moxibustion combined with phototherapy in patients with diabetic foot

Clinical observation on the improvement of scalp seborrheic dermatitis and canities with compound acid combined with microneedling

Research advance on the relationship between intestinal fungi and digestive system tumor

Clinical research progress on nutritional management during chemotherapy for gastric cancer

Exploring the differences between CASIA2 and Pentacam in preoperative evaluation of cataracts: A comparison based on measurements of anterior chamber volume, corneal thickness, and pupil diameter

Related Author

TAO Yingying

YANG Jianfeng

Related Institution

No data

AI问答

⁰