The last several years have seen significant changes in the initial management of patients with upper gastrointestinal bleeding, with more restrictive transfusion thresholds, increased use of risk stratification scores, and discontinuation of routine nasogastric tubes. In addition, there are new data and recommendations on the optimal timing of endoscopy. Concurrent with the evolution of endoscopic management, medical therapies have been developed with recent changes in proton pump inhibitor administration recommendations as well as the use of prokinetics to improve endoscopic visualization. Many modifications in endoscopic therapy have been developed, including the use of endoscopic ultrasound-guided angiotherapy, topical sprays (eg, hemostatic nanopowders), and over-the-scope clips. The medical and endoscopic management of esophageal and gastric variceal bleeding is also changing, including the use of injected glues. This issue discusses all of these important areas as well as management of rebleeding and of unusual causes of upper gastrointestinal bleeding. I highly recommend reading “Tips and Tricks on How to Optimally Manage Patients with Upper Gastrointestinal Bleeding,” which provides practical insights on improving management, as well as the “Zen of Endoscopy.”
To provide optimal care to our patients, it is critical that practicing gastroenterologists be familiar with the many recent advances in management of upper gastrointestinal bleeding. This issue of Gastrointestinal Endoscopy Clinics of North America provides a comprehensive overview of the management of patients with upper gastrointestinal bleeding by experts who provide state-of-the-art updates as well as practical clinical pearls. I am deeply indebted to all of the contributors and hope that you find this issue helpful in your practice.