Guía de práctica clínica para la evaluación y el manejo de la hemorragia digestiva alta en el Seguro Social del Perú (EsSalud): actualización 2024

Luis Cervera-Caballero; Ana Brañez-Condorena; Alejandro  Piscoya; Nelly Vásquez-Valverde; Ericson Arcana-López; Javier Contreras-Turin; Daniel Vargas-Blácido; Alvaro Taype-Rondan; Joan Caballero-Luna; Fabiola Huaroto-Ramírez

doi:10.47892/rgp.2025.452.1905

Authors

Luis Cervera-Caballero Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. https://orcid.org/0000-0003-4314-1615
Ana Brañez-Condorena Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, EsSalud, Lima, Perú. https://orcid.org/0000-0001-5518-3025
Alejandro Piscoya Hospital Guillermo Kaelin de la Fuente, EsSalud, Lima, Perú; Carrera de Medicina, Universidad Tecnológica del Perú, Lima, Perú. https://orcid.org/0000-0002-4420-2419
Nelly Vásquez-Valverde Hospital III Suárez Angamos, EsSalud, Lima, Perú. https://orcid.org/0000-0001-6091-147X
Ericson Arcana-López Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. https://orcid.org/0000-0002-8629-0883
Javier Contreras-Turin Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. https://orcid.org/0009-0009-2304-0973
Daniel Vargas-Blácido Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú. https://orcid.org/0000-0002-1305-9824
Alvaro Taype-Rondan Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, EsSalud, Lima, Perú. https://orcid.org/0000-0001-8758-0463
Joan Caballero-Luna Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, EsSalud, Lima, Perú. https://orcid.org/0000-0002-0580-9963
Fabiola Huaroto-Ramírez Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, EsSalud, Lima, Perú. https://orcid.org/0000-0002-7323-230X

DOI:

https://doi.org/10.47892/rgp.2025.452.1905

Keywords:

Gastrointestinal Hemorrhage, Practice Guideline, GRADE, Evidence-based Medicine

Abstract

Introduction: This article summarizes the clinical practice guideline (CPG) for the evaluation and management of upper gastrointestinal bleeding (UGIB) in the Social Security of Peru (EsSalud). Methods: A guideline development group comprising medical specialists and methodologists, formulated clinical questions addressed by CPG. Systematic evidence searches were conducted for each question during 2024. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of the evidence and formulate the recommendations. The CPG was approved through Resolution No. 000022–IETSI-ESSALUD-2024. Results: This CPG addressed 11 clinical questions, divided into four topics: risk assessment, initial management, variceal UGIB management, and non-variceal UGIB management. Based on these questions, 11 recommendations (7 strong recommendations and 4 weak recommendations), 24 good clinical practices, and 2 flowcharts were formulated. For the 2024 guideline update, no new evidence was found to change the recommendations' direction or strength. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for evaluating and managing UGIB in EsSalud.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Saydam ŞS, Molnar M, Vora P. The global epidemiology of upper and lower gastrointestinal bleeding in general population: A systematic review. World J Gastrointest Surg. 2023;15(4):723-739. doi: 10.4240/wjgs.v15.i4.723.

Weledji EP. Acute upper gastrointestinal bleeding: A review. Surg Pract Sci. 2020;1:100004. doi: 10.1016/j.sipas.2020.100004.

National Institute for Health and Care Excellence. Guidelines. Acute upper gastrointestinal bleeding in over 16s: management. London: National Institute for Health and Care Excellence (NICE); 2016.

Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med. 2019;171(11):805-822. doi: 10.7326/M19-1795.

Gralnek IM, Camus Duboc M, Garcia-Pagan JC, Fuccio L, Karstensen JG, Hucl T, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2022;54(11):1094-1120. doi: 10.1055/a1939-4887.

Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53(3):300-332. doi: 10.1055/a-1369-5274.

Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021;116(5):899-917. doi: 10.14309/ ajg.0000000000001245.

Vásquez-Quiroga J, Taype-Rondan A, Zafra-Tanaka JH, Arcana-López E, Cervera-Caballero L, Contreras-Turin J, et al. Guía de práctica clínica para la evaluación y el manejo de la hemorragia digestiva alta en el Seguro Social del Perú (EsSalud). Rev Gastroenterol Peru. 2018;38(1):89-102. doi: 10.47892/rgp.2018.381.876.

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017 Sep 21;358:j4008. doi: 10.1136/bmj.j4008.

Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-6. doi: 10.1016/j. jclinepi.2010.07.015.

Alonso-Coello P, Schünemann HJ, Moberg J, BrignardelloPetersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016. doi: 10.1136/bmj.i2016.

Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016;353:i2089. doi: 10.1136/bmj.i2089.

Ramaekers R, Mukarram M, Smith CA, Thiruganasambandamoorthy V. The Predictive Value of Preendoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients With Upper Gastrointestinal Bleeding: A Systematic Review. Acad Emerg Med. 2016;23(11):1218-1227. doi: 10.1111/acem.13101.

Odutayo A, Desborough MJ, Trivella M, Stanley AJ, Dorée C, Collins GS, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol. 2017;2(5):354-360. doi: 10.1016/ S2468-1253(17)30054-7.

Sreedharan A, Martin J, Leontiadis GI, Dorward S, Howden CW, Forman D, et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;2010(7):CD005415. doi: 10.1002/14651858.CD005415.pub3.

Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1-46. doi: 10.1055/s-0034-1393172.

Zhang H, Zhang H, Li H, Zhang H, Zheng D, Sun CM, et al. TIPS versus endoscopic therapy for variceal rebleeding in cirrhosis: A meta-analysis update. J Huazhong Univ Sci Technolog Med Sci. 2017;37(4):475-485. doi: 10.1007/s11596-017-1760-6.

Qiao W, Ren Y, Bai Y, Liu S, Zhang Q, Zhi F. Cyanoacrylate Injection Versus Band Ligation in the Endoscopic Management of Acute Gastric Variceal Bleeding: Meta-Analysis of Randomized, Controlled Studies Based on the PRISMA Statement. Medicine (Baltimore). 2015;94(41):e1725. doi: 10.1097/MD.0000000000001725.