Endoscopic management
Endoscopy is the mainstay of AUGIB management.
It has been recommended that all patients with
an initial Rockall score > 1 undergo endoscopic
management during working hours, within 24
hours of presentation (Barkun et al, 2003). While
there is no evidence to suggest that early endoscopy
has an effect on mortality, it has been shown to
reduce the need for transfusions and length of
stay (Spiegel et al, 2001; Barkun et al, 2003). A
benefit of early endoscopy is that it enables risk
stratification; endoscopic stigmata are included in
the Rockall scoring system, which can allow the
early safe discharge of low risk patients and improve
outcomes in those who are at higher risk. Endoscopic
treatment should be undertaken immediately after
resuscitation in all unstable patients with AUGIB,
which emphasises the importance of a 24-hour GI
bleed rota