Failed Endoscopic Hemostasis
After 2nd attempt or massive hemorrhage
All Pathways
Upper GI SurgeryManagement
Upper GI Bleeding Surgical Management (WSES)
Upper GI Bleeding Surgical Management (WSES): Failed Endoscopic Hemostasis → Hemodynamic Status → IR Candidate? → Angioembolization → Post-Op Care.
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Decision Hemodynamic Status
- Ongoing transfusion >6 units/24h
- Persistent hypotension
- Active hemorrhage on repeat EGD
03Decision IR Candidate?
- Stable for transport
- IR available 24/7
- Bleeding vessel visible
04Action Angioembolization
Selective embolization
- Celiac/SMA angiography
- GDA embolization common
05Action Post-Op Care
ICU, PPI infusion, H. pylori test
06End Recovery & Prevention
H. pylori eradication, NSAID cessation
07Action Peptic Ulcer Surgery
Suture ligation +/- resection
- Gastric: wedge resection + biopsy
- Duodenal: duodenotomy + suture
- Avoid vagotomy in acute setting
- Path rejoins step 05Shared downstream outcome
08Action Immediate Surgery
Hemodynamically unstable
- Path rejoins step 07Shared downstream outcome
09Action Non-Ulcer Source
Dieulafoy, GIST, aortoenteric
- Wedge resection or oversewing
- Aortoenteric: aortic control first
- Path rejoins step 05Shared downstream outcome
Guideline Source
WSES Guidelines for the Management of Acute Upper GI Bleeding
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Applies AFTER failed endoscopic therapy
- Variceal bleeding has separate pathway
- IR availability varies by institution
- Damage control surgery may be needed in extremis
Applicable Regions
USAUUKEU
AU: ANZGOSA upper GI emergency guidelines
UK: NICE acute upper GI bleeding pathway
US: WSES and ASGE guidelines
Version 1Next review: 2028-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Upper GI Bleeding Surgical Management (WSES)?
The Upper GI Bleeding Surgical Management (WSES) is a management clinical algorithm for Upper GI Surgery. It provides a structured decision tree to guide clinical decision-making, based on WSES Guidelines for the Management of Acute Upper GI Bleeding.
What guideline is the Upper GI Bleeding Surgical Management (WSES) based on?
This algorithm is based on WSES Guidelines for the Management of Acute Upper GI Bleeding (DOI: 10.1186/s13017-023-00493-1).
What are the limitations of the Upper GI Bleeding Surgical Management (WSES)?
Known limitations include: Applies AFTER failed endoscopic therapy; Variceal bleeding has separate pathway; IR availability varies by institution; Damage control surgery may be needed in extremis. Individual patient factors may require deviation from these recommendations.
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