【ESGE最新指南】非静脉曲张性上消化道出血的内镜诊断和管理
Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline-Update 2021
非静脉曲张性上消化道出血（NVUGIH）的内镜诊断和管理：欧洲胃肠内镜学会（ESGE）指南-2021更新版
Summary of Guideline statements and recommendations.
指南声明和建议汇总
Initial patient evaluation and hemodynamic resuscitation
患者的初始评估和血流动力学复苏
1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists.
ESGE建议：立即评估急性上消化道出血（UGIH）患者的血流动力学状态，如果血流动力学不稳定，应首先使用晶体液及时补充血容量。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Red blood cell (RBC) transfusion strategy
红细胞（RBC）输注策略
2. ESGE recommends, in hemodynamically stable patients with acute UGIH and no history of cardiovascular disease, a restrictive RBC transfusion strategy with a hemoglobin threshold of ≤ 7 g/dL prompting RBC transfusion. A post-transfusion target hemoglobin concentration of 7–9 g/dL is desired.
ESGE建议：对无心血管疾病史且血流动力学稳定的急性UGIH患者，采用限制性RBC输注策略，即血红蛋白阈值≤7 g/dL时，提示需要输注RBC。期望输血后达到目标血红蛋白浓度7-9 g/dL。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
3. ESGE recommends in hemodynamically stable patients with acute UGIH and a history of acute or chronic cardiovascular disease, a more liberal RBC transfusion strategy with a hemoglobin threshold of ≤ 8 g/dL prompting RBC transfusion. A post transfusion target hemoglobin concentration of ≥ 10 g/dL is desired.
ESGE建议：对有急性或慢性心血管疾病史且血流动力学稳定的急性UGIH患者，采用开放性RBC输注策略，即血红蛋白阈值≤8 g/dL时，提示需要输注RBC。期望输血后达到目标血红蛋白浓度≥10 g/dL。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Patient risk stratification
患者风险分层
4. ESGE recommends in patients with acute UGIH the use of the Glasgow-Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.
ESGE建议：在内镜管理前利用Glasgow-Blatchford评分（GBS）对急性UGIH患者进行风险分层。GBS≤1的患者再出血、30天内死亡或需要住院干预的风险极低，并可在门诊接受安全的门诊内镜管理。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
Management of antithrombotic agents (antiplatelet agents and anticoagulants)
抗血栓药物（抗血小板药物和抗凝剂）的管理
5. ESGE recommends that in patients with acute UGIH who are taking low dose aspirin as monotherapy for primary cardiovascular prophylaxis, aspirin should be temporarily interrupted. Aspirin can be re-started after careful re-evaluation of its clinical indication.
ESGE建议：对于正在将低剂量阿司匹林作为心血管疾病一级预防单药治疗的急性UGIH患者，应暂时中断阿司匹林治疗。在仔细重新评估阿司匹林的临床适应症后，可以重新开始阿司匹林治疗。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
6. ESGE recommends that in patients with acute UGIH who are taking low dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3-5 days.
ESGE建议：对于正在将低剂量阿司匹林作为心血管疾病二级预防单药治疗的急性UGIH患者，不应中断阿司匹林治疗。如果因任何原因中断了阿司匹林的治疗，应尽快（最好在3-5天内）重新开始进行阿司匹林治疗。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
7. ESGE recommends that in patients with acute UGIH who are taking dual antiplatelet therapy (DAPT) for secondary cardiovascular prophylaxis, aspirin should not be interrupted. The second antiplatelet agent should be interrupted, but re-started as soon as possible, preferably within 5 days. Cardiology consultation is suggested.
ESGE建议：对于正在将双联抗血小板治疗（DAPT）作为心血管疾病二级预防的急性UGIH患者，不应中断阿司匹林治疗。而应中断第二种抗血小板药物的治疗，但应尽快（最好在5天内）重新开始治疗。建议进行心脏科会诊。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
8. ESGE does not recommend routine platelet transfusion for patients with acute NVUGIH who are taking antiplatelet agents.
ESGE建议：请勿对正在服用抗血小板药物的急性NVUGIH患者常规输注血小板。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
9. ESGE does not recommend the use of tranexamic acid in patients with acute NVUGIH.
ESGE建议：请勿在急性NVUGIH患者中使用氨甲环酸。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
10. ESGE recommends that in patients with acute UGIH taking vitamin K antagonists (VKAs), that the anticoagulant be withheld.
ESGE建议：对于正在服用维生素K拮抗剂（VKA）的急性UGIH患者，应停用抗凝剂。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
11. ESGE recommends that in patients with acute UGIH taking vitamin K antagonists (VKAs) who have hemodynamic instability, low dose vitamin K supplemented with intravenous prothrombin complex concentrate (PCC), or fresh frozen plasma (FFP) if PCC is not available, should be administered. However, this should not delay endoscopy or if required, endoscopic hemostasis.
ESGE建议：对于正在服用维生素K拮抗剂（VKA）且血流动力学不稳定的急性UGIH患者，应给予低剂量的维生素K并辅以静脉给予凝血酶原复合物（PCC）或新鲜冷冻血浆（FFP）（如果PCC不可用）。但是，这不应延迟内镜管理或必要的内镜止血。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
12. ESGE recommends that in patients with acute UGIH taking direct oral anticoagulants (DOAC), the anticoagulant should be withheld and endoscopy not delayed. In patients with severe ongoing bleeding, use of a DOAC reversal agent or intravenous PCC should be considered.
ESGE建议：对于正在服用直接口服抗凝剂（DOAC）的急性UGIH患者，应停用抗凝剂，但不得延迟内镜管理。在重度持续出血患者中，应考虑使用DOAC逆转剂或静脉给予PCC。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Proton pump inhibitor (PPI) therapy
质子泵抑制剂（PPI）治疗
13. ESGE suggests that pre-endoscopy high dose intravenous proton pump inhibitor (PPI) therapy be considered in patients presenting with acute UGIH, to downstage endoscopic stigmata and thereby reduce the need for endoscopic therapy; however, this should not delay early endoscopy.
ESGE建议：内镜管理前应考虑对急性UGIH患者静脉给予高剂量质子泵抑制剂（PPI），以减少出血的内镜下高危特征，从而减少不必要的内镜治疗，但不应延迟早期内镜管理。
Weak recommendation, high quality evidence.
弱推荐，证据质量较高。
Somatostatin and somatostatin analogues
生长抑素和生长抑素类似物
14. ESGE does not recommend the use of somatostatin, or its analogue octreotide, in patients with NVUGIH.
ESGE建议：请勿在NVUGIH患者中使用生长抑素或生长抑素类似物奥曲肽。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Nasogastric/orogastric tube aspiration and lavage
鼻胃管/口胃管抽吸和灌洗
15. ESGE does not recommend the routine use of nasogastric or orogastric aspiration/lavage in patients presenting with acute UGIH.
ESGE建议：请勿在急性UGIH患者中常规使用鼻胃管或口胃管进行抽吸/灌洗。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
Endotracheal intubation
气管插管
16. ESGE does not recommend routine prophylactic endotracheal intubation for airway protection prior to upper endoscopy in patients with acute UGIH.
ESGE建议：对于急性UGIH患者，在上消化道内镜管理前，请勿进行常规预防性气管插管以保护气道。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
17. ESGE recommends prophylactic endotracheal intubation for airway protection prior to upper endoscopy only in selected patients with acute UGIH (i. e., those with ongoing active hematemesis, agitation, or encephalopathy with inability to adequately control the airway).
ESGE建议：仅对于特定的急性UGIH患者（即，持续性呕血、激越，或脑病且无法充分控制气道的患者），可在上消化道内镜管理前进行预防性气管插管以保护气道。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Prokinetic medications
促胃动力药
18. ESGE recommends pre-endoscopy administration of intravenous erythromycin in selected patients with clinically severe or ongoing active UGIH.
ESGE建议：对于特定的临床重度或持续活动性UGIH患者，在内镜管理前静脉给予红霉素。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
Timing of upper GI endoscopy
上消化道内镜管理的时间
1. ESGE recommends adopting the following definitions regarding the timing of upper GI endoscopy in acute UGIH relative to the time of patient presentation: urgent ≤ 12 hours, early ≤ 24 hours, and delayed > 24 hours.
ESGE建议：对于急性UGIH患者，进行上消化道内镜管理的时间，采用以下定义（相对于患者就诊时间）：紧急≤12小时、早期≤24小时和延迟> 24小时。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
2. ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper GI endoscopy should be performed.
ESGE建议：在血流动力学复苏后，应行早期（≤24小时）上消化道内镜管理。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
3. ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved.
ESGE建议：请勿行紧急（≤12小时）上消化道内镜管理，因为与早期内镜管理相比，患者结局没有更好。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
4. ESGE does not recommend emergent (≤ 6 hours) upper GI endoscopy since this may be associated with worse patient outcomes.
ESGE建议：请勿行超紧急（≤6小时）上消化道内镜管理，因为这会导致较差的患者结局。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
5. ESGE recommends that the use of antiplatelet agents, anticoagulants, or a predetermined international normalized ratio (INR) cutoff level, should not be used to define or guide the timing of upper GI endoscopy in patients with acute UGIH.
ESGE建议：在急性UGIH患者中，不应使用抗血小板药物、抗凝剂或预先确定的国际标准化比值（INR）截断值来界定或指导上消化道内镜管理的时机。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
On-call GI endoscopy resources
随时待命的GI内镜资源
6. ESGE recommends the availability of both an on-call GI endoscopist proficient in endoscopic hemostasis and on-call nursing staff with technical expertise in the use of endoscopic devices, to allow performance of endoscopy on a 24/7 basis.
ESGE建议：要保证一名熟练掌握内镜止血的GI内镜医师和一名具有内镜器械使用技术专业知识的护理人员随时待命，以便可以全天候地进行内镜管理。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Endoscopic diagnosis
内镜诊断
7. ESGE recommends the Forrest (F) classification be used in all patients with peptic ulcer hemorrhage to differentiate low risk and high risk endoscopic stigmata.
ESGE建议：在所有的消化性溃疡出血患者中使用Forrest（F）分级来区分出血的内镜下低危和高危特征。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
8. ESGE recommends that peptic ulcers with spurting or oozing bleeding (FIa and FIb respectively) or with a nonbleeding visible vessel (FIIa) receive endoscopic hemostasis because these lesions are at high risk for persistent bleeding or recurrent bleeding.
ESGE建议：对喷射性出血（FIa）、渗血（FIb）或可见裸露血管但无出血（FIIa）的消化性溃疡患者进行内镜止血，因为这些病变出现持续性出血或复发性出血的风险较高。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
9. ESGE suggests that peptic ulcers with an adherent clot (FIIb) be considered for endoscopic clot removal. Once the clot is removed, any identified underlying active bleeding (FIa or FIb) or nonbleeding visible vessel (FIIa) should receive endoscopic hemostasis.
ESGE建议：应考虑对黏附血凝块（FIIb）消化性溃疡患者进行内镜治疗，以清除血凝块。清除血凝块后，应对所有确定的潜在活动性出血（FIa或FIb）或可见裸露血管但无出血（FIIa）的消化性溃疡患者进行内镜止血。
Weak recommendation, moderate quality evidence.
弱推荐，证据质量中等。
10. ESGE does not recommend endoscopic hemostasis in patients with peptic ulcers having a flat pigmented spot (FIIc) or clean base (FIII), as these stigmata have a low risk of adverse outcomes. In selected clinical settings these patients may have expedited hospital discharge.
ESGE建议：请勿对具有扁平黑色基底（FIIc）或基底洁净（FIII）的消化性溃疡患者进行内镜止血，因为这些特征意味着出现不良结局的风险较低。在特定的临床情况下，这些患者可能可以快速出院。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
11. ESGE does not recommend the routine use of Doppler endoscopic probe in the evaluation of endoscopic stigmata of peptic ulcer bleeding.
ESGE建议：请勿常规使用多普勒内镜探头来评估消化性溃疡出血的内镜下特征。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
12. ESGE does not recommend the routine use of capsule endoscopy technology in the evaluation of acute UGIH.
ESGE建议：请勿常规使用胶囊式内镜技术来评估急性UGIH。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Endoscopic therapy for peptic ulcer hemorrhage
消化性溃疡出血的内镜治疗
13 . FIa, FIb (active bleeding)
FIa，FIb（活动性出血）
(a) ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy).
ESGE建议：对于溃疡活动性出血（FIa，FIb）患者，应使用肾上腺素注射联合第二种止血方式进行止血（接触性热凝固治疗或机械治疗）。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
(b) ESGE suggests that in selected actively bleeding ulcers (FIa,FIb), specifically those > 2 cm in size, with a large visible vessel > 2mm, or located in a high-risk vascular area (e. g., gastroduodenal, left gastric arteries), or in excavated/fibrotic ulcers, endoscopic hemostasis using a cap-mounted clip should be considered as first-line therapy.
ESGE建议：在特定的溃疡活动性出血（FIa、FIb）患者中，尤其是> 2 cm的溃疡，可见大型（> 2 mm）血管，或位于风险较高的血管区域（如胃十二指肠、胃左动脉），或位于凹陷型/纤维化溃疡中，应将使用配有透明帽的钛夹的内镜下止血视为一线治疗。
Weak recommendation, low quality evidence.
弱推荐，证据质量较低。
14. FIIa (nonbleeding visible vessel)
FIIa（可见裸露血管但无出血）
ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection.
ESGE建议：对于可见裸露血管但无出血的（FIIa）溃疡患者，可进行接触性或非接触性热凝固治疗、机械治疗或注射硬化剂，这些疗法可作为单一疗法或联合肾上腺素注射。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
15. ESGE does not recommend that epinephrine injection be used as endoscopic monotherapy. If used, it should be combined with a second endoscopic hemostasis modality.
ESGE建议：请勿将肾上腺素注射作为内镜下止血的单一疗法。如果使用的话，应联合另一种内镜止血方式。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
16. ESGE recommends that persistent bleeding be defined as ongoing active bleeding refractory to standard hemostasis modalities.
ESGE建议：将持续性出血定义为标准止血方式难治的持续性活动性出血。
Strong recommendation, high quality evidence.
强推荐，证据质量较高
17. ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered.
ESGE建议：对于标准止血方式难治的持续性出血患者，应考虑使用局部止血喷雾/粉末或配有透明帽的钛夹进行止血。
Weak recommendation, low quality evidence.
弱推荐，证据质量较低。
18. ESGE recommends that in patients with persistent bleeding refractory to all modalities of endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE.
ESGE建议：对于所有内镜止血方式均无效的持续性出血患者，应考虑使用经导管血管造影栓塞术（TAE）进行治疗。当TAE不可用或TAE失败后，可以进行手术。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
19. ESGE suggests considering the use of hemostatic forceps as an alternative endoscopic hemostasis option in peptic ulcer hemorrhage.
ESGE建议：对于消化性溃疡出血患者，可以考虑将止血钳作为内镜止血的另一种选择。
Weak recommendation, moderate quality evidence.
弱推荐，证据质量中等。
Proton pump inhibitor (PPI) therapy
质子泵抑制剂（PPI）治疗
1. ESGE recommends high dose PPI therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically.
ESGE建议：对于接受内镜止血的患者以及未接受内镜治疗且出现FIIb溃疡特征（黏附血凝块）的患者，进行高剂量PPI治疗。
(a) PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80mg then 8 mg/hour) for 72 hours post endoscopy.
应在内镜操作后静脉推注PPI，随后进行连续输注（例如，先推注80 mg，然后以8 mg/小时进行连续输注），持续72小时。
(b) High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.
可将静脉推注给药（每日两次）或口服药剂（每日两次）的高剂量PPI治疗视为替代方案。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
Second-look endoscopy
二次内镜治疗
2. ESGE does not recommend routine second-look endoscopy as part of the management of NVUGIH.
ESGE建议：请勿将常规二次内镜治疗作为NVUGIH治疗的一部分。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
Management of recurrent bleeding
复发性出血的管理
3. ESGE recommends that recurrent bleeding be defined as bleeding following initial successful endoscopic hemostasis.
ESGE建议：将复发性出血定义为初次成功内镜止血后的出血。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
4. ESGE recommends that patients with clinical evidence of recurrent bleeding should receive repeat upper endoscopy with hemostasis if indicated.
ESGE建议：对于有反复出血临床证据的患者，应再次进行上消化道内镜检查，如有指征，应进行止血。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
5. ESGE recommends that in the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE.
ESGE建议：对于第二次内镜下止血尝试失败的情况，应考虑进行经导管血管造影栓塞术（TAE）。当TAE不可用或TAE失败后，可进行手术。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
6. ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE.
ESGE建议：对于有复发性消化性溃疡出血临床证据的患者，应考虑使用配有透明帽的钛夹进行止血。在第二次内镜止血尝试失败的情况下，应考虑进行经导管血管造影栓塞术（TAE）。当TAE不可用或TAE失败后，可进行手术。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
Helicobacter pylori
幽门螺杆菌
7. ESGE recommends, in patients with NVUGIH secondary to peptic ulcer, investigation for the presence of Helicobacter pylori in the acute setting (at index endoscopy) with initiation of appropriate antibiotic therapy when H. pylori is detected.
ESGE建议：对于继发于消化性溃疡的NVUGIH患者，在急性条件下（首次内镜检查时）检查是否存在幽门螺杆菌，当检测到幽门螺杆菌时，开始进行适当的抗生素治疗。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
8. ESGE recommends re-testing for H. pylori in those patients with a negative test at index endoscopy.
ESGE建议：在首次内镜检查阴性的患者中重新检测幽门螺杆菌。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
9. ESGE recommends documentation of successful H. pylori eradication.
ESGE建议：将成功根除幽门螺杆菌的过程记录下来。
Strong recommendation, high quality evidence.
强推荐，证据质量较高。
Dual antiplatelet therapy and PPI co-therapy
双联抗血小板治疗和PPI协同治疗
10. ESGE recommends that in patients who have had acute NVUGIH and require ongoing dual antiplatelet therapy (DAPT), PPI should be given as co-therapy.
ESGE建议：对于急性NVUGIH且需要持续进行双联抗血小板治疗（DAPT）的患者，应给予PPI协同治疗。
Strong recommendation, moderate quality evidence.
强推荐，证据质量中等。
Re-starting anticoagulation therapy (vitamin K antagonists [VKAs], direct oral anticoagulants [DOACs])
重新开始抗凝治疗（维生素K拮抗剂[VKA]、直接口服抗凝药物[DOAC]）
11. ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.
ESGE建议：对于急性NVUGIH（例如消化性溃疡出血）后需要持续进行抗凝治疗的患者，基于血栓栓塞风险，一旦出血得到控制，应尽快（最好是在出血事件发生7天内或7天后）恢复抗凝治疗。在这种情况下，应考虑到，与维生素K拮抗剂（VKA）相比，直接口服抗凝剂（DOACS）起效更快。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
12. ESGE recommends PPIs for gastroduodenal prophylaxis in patients requiring ongoing anticoagulation and with a history of NVUGIH.
ESGE建议：对于需要持续进行抗凝治疗且有NVUGIH病史的患者，应将PPI作为胃十二指肠疾病的预防性用药。
Strong recommendation, low quality evidence.
强推荐，证据质量较低。
Reference:
Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, Laursen SB, Radaelli F, Papanikolaou IS, Cúrdia Gonçalves T, Dinis-Ribeiro M, Awadie H, Braun G, de Groot N, Udd M, Sanchez-Yague A, Neeman Z, van Hooft JE. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021 Mar;53(3):300-332. doi: 10.1055/a-1369-5274. Epub 2021 Feb 10. PMID: 33567467.
声明：
本文翻译为来自柳叶新潮团队编辑整理，仅供学习交流。