title: What Does Lesion Blood Flow Tell Us About Risk Stratification and Successful Management of Non-variceal UGI Bleeding?
abstract: OBJECTIVE
  There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ulcers, Dieulafoy lesions, and Mallory-Weiss tears), including the use of the Doppler endoscopic probe (DEP).
  
  
  RESULTS
  Prospective studies evaluating the use of DEP in non-variceal UGI hemorrhage showed that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared to those with intermediate-risk SRH. Additionally, lesions with a persistently positive DEP signal after endoscopic hemostasis were seen with high-risk SRH and had a higher 30-day rebleeding rate. Residual arterial blood flow underneath ulcers is a significant risk factor for rebleeding. However, if more endoscopic treatment is applied, clinical outcomes for patients with severe non-variceal UGI hemorrhage are improved, as documented by a recent CURE Hemostasis randomized controlled trial (RCT).
authors.affiliation: Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza #205, Los Angeles, CA, 90095, USA. kghassemi@mednet.ucla.edu.|CURE Digestive Diseases Research Center, Los Angeles, USA. kghassemi@mednet.ucla.edu.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ghassemi
authors.affiliation: Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza #205, Los Angeles, CA, 90095, USA.|CURE Digestive Diseases Research Center, Los Angeles, USA.|Department of Medicine, West Los Angeles VA Medical Center, Los Angeles, USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Jensen
mesh_terms: D016099:Endoscopy, Gastrointestinal / Q000379:methods; D019160:Endosonography / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D041981:Gastrointestinal Tract / Q000098:blood supply*; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D012039:Regional Blood Flow; D018570:Risk Assessment / Q000379:methods
keywords: Doppler endoscopic probe; Risk stratification; Upper gastrointestinal bleeding