Abstract
It has well been established that endoscopy is the first-line diagnostic and therapeutic intervention for patients presenting with hematoemesis or melena. However, the role of endoscopy has to be considered in the context of the entire management of upper gastrointestinal bleeding, which involves initial resuscitation to stabilize a shocked patient and subsequent treatment to arrest hemorrhage using endoscopy, interventional radiology, or surgery. The present review addresses not only the basic skill of endoscopic procedure but also the importance of periprocedual management . The following issues are especially stressed : 1)prompt and effective intravascular volume repletion by infusing crystalloid and blood products is the mainstay for therapeutic success, 2)the most optimal stategy for hemostatic intervention should be determined based on patient's hemodynamic status, 3)if indicated, endoscopy should be performed gently and carefully to achieve accurate diagnosis and successful endoscopic therapy, and 4)the appropriate timing of converting endoscopic treatment to interventional radiology or surgery should always be considered.
