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Z Gastroenterol 2022; 60(07): 1139-1145
DOI: 10.1055/a-1788-3501
Leitlinie

Addendum zur S2k-Leitlinie Gastrointestinale Blutungen der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

Addendum Dezember 2021 – AWMF-Reg. Nr. 021-28, Versionsnummer 1.1Unter Mitarbeit folgender Fachgesellschaften
Martin Götz
1   Medizinische Klinik IV – Gastroenterologie/Onkologie, Klinikum Sindelfingen-Böblingen, Böblingen, Deutschland
,
Erwin Biecker
2   Abteilung Innere Medizin mit Schwerpunkt Gastroenterologie, Zollernalb Klinikum Balingen, Balingen, Deutschland
,
Alexander Dechêne
3   Medizinische Klinik 6 mit Schwerpunkt Gastroenterologie, Klinikum Nord, Nürnberg, Deutschland
,
Dieter Schilling
4   Medizinische Klinik II mit Schwerpunkt Gastroenterologie, Diakonissenkrankenhaus Mannheim, Mannheim, Deutschland
,
Alexander Zipprich
5   Klinik für Innere Medizin IV Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Jena, Jena, Deutschland
,
Jonel Trebicka
6   Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Deutschland
,
Collaborators
, Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (federführend), Deutsche Morbus Crohn und Colitis ulcerosa Vereinigung (DCCV), Deutsche Röntgengesellschaft (DRG), Deutsche Gesellschaft für interventionelle Radiologie (DeGiR), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) und Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonografie (CAES) der DGAV, Deutsche Gesellschaft für Internistische Intensivmedizin (DGIIN), Deutsche Gesellschaft für Innere Medizin (DGIM), Deutsche Gesellschaft für Kardiologie (DGK), Akademie für Ethik in der Medizin (AEM), Gesellschaft für Thrombose und Hämostaseforschung (GTH) › Author Affiliations
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1. Präambel

Aufgrund der neueren Daten in den vergangenen Jahren, die insbesondere die praktische Umsetzung der S2k-Leitlinie Gastrointestinale Blutungen betreffen, wurde ein Addendum zur Leitlinie notwendig. Das Addendum fokussiert auf die typischen Fragestellungen, wie den Zeitpunkt und die Methoden der Behandlung der akuten gastrointestinalen Blutung, Anwendung von Antikoagulanzien und deren Steuerung. Alle in der Leitlinie aufgeführten Themen sollen in den Jahren 2023–2025 bei der Aktualisierung dieser Leitlinie erneut bearbeitet werden.

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Publication History

Article published online:
11 July 2022

© 2022. Thieme. All rights reserved.

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  • Literatur

  • 1 Lau JYW, Yu Y, Tang RSY. et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. N Engl J Med 2020; 382: 1299-1308
    CrossrefPubMedGoogle Scholar
  • 2 Cho SH, Lee YS, Kim YJ. et al. Outcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2018; 16: 370-377
    CrossrefPubMedGoogle Scholar
  • 3 Laursen SB, Leontiadis GI, Stanley AJ. et al. Relationship between timing of endoscopy and mortality in patients with peptic ulcer bleeding: a nationwide cohort study. Gastrointest Endosc 2017; 85: 936-944 e3
    CrossrefPubMedGoogle Scholar
  • 4 Niikura R, Nagata N, Yamada A. et al. Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding. Gastroenterology 2020; 158: 168-175 e6
    CrossrefPubMedGoogle Scholar
  • 5 van Rongen I, Thomassen BJW, Perk LE. Early Versus Standard Colonoscopy: A Randomized Controlled Trial in Patients With Acute Lower Gastrointestinal Bleeding: Results of the BLEED Study. J Clin Gastroenterol 2019; 53: 591-598
    CrossrefPubMedGoogle Scholar
  • 6 Anvari S, Lee Y, Yu J. et al. Urgent Versus Standard Colonoscopy for Management of Acute Lower Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Gastroenterol 2020; 54: 493-502
    CrossrefPubMedGoogle Scholar
  • 7 Zhou Z, Zhao N, Shu Y. et al. Effect of Gastrointestinal Symptoms in Patients With COVID-19. Gastroenterology 2020; 158: 2294-2297
    CrossrefPubMedGoogle Scholar
  • 8 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475-481
    CrossrefPubMedGoogle Scholar
  • 9 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey. Endoscopy 2020; 52: 891-898
    Google Scholar
  • 10 Cavaliere K, Levine C, Wander P. et al. Management of upper GI bleeding in patients with COVID-19 pneumonia. Gastrointest Endosc 2020; 92: 454-455
    CrossrefPubMedGoogle Scholar
  • 11 Trindade AJ, Izard S, Coppa K. et al Gastrointestinal bleeding in hospitalized COVID-19 patients: a propensity score matched cohort study. J Intern Med 2021; 289 (06) 887-894
    CrossrefPubMedGoogle Scholar
  • 12 Bennett C, Klingenberg SL, Langholz E. et al Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev 2014:CD006640
    PubMedGoogle Scholar
  • 13 Collaborators H-IT. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020; 395: 1927-1936
    CrossrefPubMedGoogle Scholar
  • 14 Gouriou C, Bouguen G, Lahmek P. et al. Outcomes of upper gastrointestinal bleeding are similar between direct oral anticoagulants and vitamin K antagonists. Aliment Pharmacol Ther 2021; 53: 688-695
    PubMedGoogle Scholar
  • 15 Kwon S, Lee SR, Choi EK. et al. Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Prior Gastrointestinal Bleeding. Stroke 2021; 52: 511-520
    CrossrefPubMedGoogle Scholar
  • 16 Lau LH, Guo CL, Yip TC. et al Risks of post-colonoscopic polypectomy bleeding and thromboembolism with warfarin and direct oral anticoagulants: a population-based analysis. Gut 2022; 71 (01) 100-110
    CrossrefPubMedGoogle Scholar
  • 17 Oh HJ, Ryu KH, Park BJ. et al. The risk of gastrointestinal hemorrhage with non-vitamin K antagonist oral anticoagulants: A network meta-analysis. Medicine (Baltimore) 2021; 100: e25216
    CrossrefPubMedGoogle Scholar
  • 18 Radadiya D, Devani K, Brahmbhatt B. et al Major gastrointestinal bleeding risk with direct oral anticoagulants: Does type and dose matter? – A systematic review and network meta-analysis. Eur J Gastroenterol Hepatol 2021; 33 (Suppl. 01) e50-e58
    CrossrefPubMedGoogle Scholar
  • 19 Wedi E, Fischer A, Hochberger J. et al. Multicenter evaluation of first-line endoscopic treatment with the OTSC in acute non-variceal upper gastrointestinal bleeding and comparison with the Rockall cohort: the FLETRock study. Surg Endosc 2018; 32: 307-314
    CrossrefPubMedGoogle Scholar
  • 20 Jensen DM, Kovacs T, Ghassemi KA. et al Randomized Controlled Trial of Over-the-Scope Clip as Initial Treatment of Severe Nonvariceal Upper Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2021; 19 (11) 2315-2323.e2
    CrossrefPubMedGoogle Scholar
  • 21 Schmidt A, Golder S, Goetz M. et al. Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers. Gastroenterology 2018; 155: 674-686 e6
    CrossrefPubMedGoogle Scholar
  • 22 Haddara S, Jacques J, Lecleire S. et al. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the „GRAPHE“ registry). Endoscopy 2016; 48: 1084-1095
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Alzoubaidi D, Hussein M, Rusu R. et al. Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray. Dig Endosc 2020; 32: 96-105
    CrossrefPubMedGoogle Scholar
  • 24 Hussein M, Alzoubaidi D, Lopez MF. et al. Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry. Endoscopy 2021; 53: 36-43
    Google Scholar
  • 25 Kwek BEA, Ang TL, Ong PLJ. 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 Dig Dis 2017; 18: 323-329
    CrossrefPubMedGoogle Scholar
  • 26 Chen YI, Wyse J, Lu Y. et al. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc 2020; 91: 321-328 e1
    Google Scholar
  • 27 Ibrahim M, El-Mikkawy A, Abdel Hamid M. et al. Early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding: a randomised trial. Gut 2019; 68: 844-853
    CrossrefPubMedGoogle Scholar
  • 28 de Nucci G, Reati R, Arena I. et al. Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding. Endoscopy 2020; 52: 773-779
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Subramaniam S, Kandiah K, Chedgy F. et al. A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection: a randomized controlled trial. Endoscopy 2021; 53: 27-35
    Google Scholar
  • 30 Garcia-Pagan JC, Caca K, Bureau C. et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362: 2370-2379
    CrossrefPubMedGoogle Scholar
  • 31 Garcia-Pagan JC, Di Pascoli M, Caca K. et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol 2013; 58: 45-50
    CrossrefPubMedGoogle Scholar
  • 32 Lv Y, Yang Z, Liu L. et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: a randomised controlled trial. Lancet Gastroenterol Hepatol 2019; 4: 587-598
    CrossrefPubMedGoogle Scholar
  • 33 Dunne PDJ, Sinha R, Stanley AJ. et al. Randomised clinical trial: standard of care versus early-transjugular intrahepatic porto-systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding. Aliment Pharmacol Ther 2020; 52: 98-106
    CrossrefPubMedGoogle Scholar
  • 34 Nicoară-Farcău O, Han G, Rudler M. et al. Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data. Gastroenterology 2021; 160: 193-205.e10
    CrossrefPubMedGoogle Scholar
  • 35 Zhou GP, Jiang YZ, Sun LY. et al. Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis. Eur Radiol 2021; 31 (07) 5390-5399
    CrossrefPubMedGoogle Scholar
  • 36 Lv Y, Zuo L, Zhu X. et al. Identifying optimal candidates for early TIPS among patients with cirrhosis and acute variceal bleeding: a multicentre observational study. Gut 2019; 68: 1297-1310
    CrossrefPubMedGoogle Scholar
  • 37 Hernandez-Gea V, Procopet B, Giraldez A. et al. Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study. Hepatology 2019; 69: 282-293
    CrossrefPubMedGoogle Scholar
  • 38 Trebicka J, Gu W, Ibáñez-Samaniego L. et al. Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS. J Hepatol 2020; 73: 1082-1091
    CrossrefPubMedGoogle Scholar