Endoscopic management of upper GI bleed

Forrest classification helps to predict who is at high-risk of re-bleed
1a: active, pulsatile bleeding. 50-90% rebleed
1b: active, non-pulsatile bleeding, 10-50% rebleed

2a: no active bleed, visible vessel. high risk rebleed (50-80%)
2b: adherent clot. low risk rebleed

3: no visible stigmata of bleeding. low risk rebleed

If you inject high risk lesions with 1:10,000 epinephrine risk of rebleed ~10-30%
other option is endoscopic coagulation or clips

Reasonable to repeat endoscopy in the case of rebleed

Consider OR if:
- large ulcer
- large bleeding vessel
- eldery >60
- active hemorrhage
- hypotension

angiography plays little role in controlling gastric ulcer bleeding as the vascular network is too rich