Complications
Rebleeding usually occurs within the first 24 hours and most often in patients with risk factors. Bleeding after endoscopic therapy is rare. Most cases of rebleeding have been described in older women with hiatus hernia.
Usually related to the acuity, severity of bleeding, and associated coronary artery disease.
Myocardial ischaemia/infarct may be a concern in a patient with atypical chest pain and a history of coronary artery disease. Careful monitoring is required due to the potential cardiovascular complications induced by adrenaline.[80] Adrenaline should be avoided in patients with known cardiovascular disease. Cardiac enzymes (CK, CK-MB, and troponin) and ECG monitoring may be helpful in this situation.
Has been described during endoscopic adrenaline injection.[81]
Has been described during endoscopic adrenaline injection.[81]
Usually related to acuity and severity of bleeding; however, shock is rare in patients with early stabilisation and prompt treatment.
Oesophageal perforation carries a high mortality secondary to rapidly developing mediastinitis and sepsis. It should be suspected in patients with retrosternal or epigastric pain with interscapular radiation, dyspnoea, cyanosis, and fever.
Conventional radiology may be the initial test in order to diagnose oesophageal perforation. CT scan with an iodine contrast may help to confirm the diagnosis. Survival improves dramatically if the injury is recognised and treated within 24 hours.
Initial electrolyte evaluation and rapid replacement is imperative in patients with intractable vomiting.
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