Treatment of Acute Esophageal Necrosis Presenting with Active Esophageal Bleeding
When acute esophageal necrosis is complicated by active esophageal bleeding, achieving prompt hemostasis becomes the immediate clinical priority. This scenario requires a targeted endoscopic approach guided by current evidence.
Clinical scenario
The patient has acute esophageal necrosis with active esophageal bleeding — a situation in which hemorrhage control must be addressed as part of the overall management.
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Primary clinical goal: Control of active esophageal bleeding — achieving endoscopic hemostasis.
Approach
Management centres on endoscopic hemostasis. At least one well-established endoscopic technique is used to control active bleeding at the site of necrosis; an alternative endoscopic strategy is also available when initial measures are insufficient. Certain mechanical tamponade methods are specifically contraindicated in this setting.
Full intervention sequence, contraindication details, and decision criteria available in the complete structured protocol →
References
DOI: 10.20524/aog.2019.0418
- Active esophageal bleeding, if present, can be controlled with submucosal adrenaline injection.
- Endoscopic placement of a self-expandable metallic covered stent is another effective strategy for achieving hemostasis.
- Balloon tamponade with a Sengstaken-Blakemore tube should be avoided, because it has been associated with perforation.
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