Clin Endosc.  2015 Mar;48(2):96-101. 10.5946/ce.2015.48.2.96.

Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art

Affiliations
  • 1Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan. muguruma.clin.med@gmail.com

Abstract

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.

Keyword

Hemorrhage; Hemostasis; Equipment and supplies

MeSH Terms

Emergencies
Endoscopy
Equipment and Supplies
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic
Hospitalization
Humans
Mortality
Radiology, Interventional

Figure

  • Fig. 1 Strategy algorithm for the management of suspected upper gastrointestinal (GI) bleeding. EGD, esophagogastroduodenoscopy; PPI, proton pump inhibitor; CT, computed tomography.

  • Fig. 2 Endoscopic features according to the Forrest classification. (A) Active spurting bleeding (IA). (B) Active oozing bleeding (IB). (C) No active bleeding with visible vessel (IIA). (D) Broad adherent clot (IIB). (E) Hematin-covered flat spots (IIC). (F) No bleeding stigmata with clean base ulcer (III).

  • Fig. 3 Endoscopic hemostatic devices. (A) Injecting epinephrine solution into the base. (B) Mechanical clips with long arms (left) and short arms (right). (C) Clip deployment. (D) Argon plasma coagulation for active oozing from telangiectasia (square). (E) Grasping the bleeding vessel with coagulation forceps. (F) Successful burnout.

  • Fig. 4 Supporting apparatuses for endoscopic hemostasis. (A) Active flowing bleeding. (B) Identifying the bleeding point with a waterjet. (C) Overtube. (D) Cap-mounted endoscope. (E) Visualization of exposed vessel with the cap. (F) Multibending scope with double working channels.


Reference

1. Bardou M, Benhaberou-Brun D, Le Ray I, Barkun AN. Diagnosis and management of nonvariceal upper gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol. 2012; 9:97–104. PMID: 22230903.
Article
2. Barkun A, Bardou M, Marshall JK. Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2003; 139:843–857. PMID: 14623622.
Article
3. Sung JJ, Chan FK, Chen M, et al. Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding. Gut. 2011; 60:1170–1177. PMID: 21471571.
Article
4. Al Dhahab H, Barkun A. The acute management of nonvariceal upper gastrointestinal bleeding. Ulcers. 2012; 2012:1–8.
Article
5. Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012; 75:1132–1138. PMID: 22624808.
Article
6. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996; 38:316–321. PMID: 8675081.
Article
7. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000; 356:1318–1321. PMID: 11073021.
Article
8. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Piscopo R. Outpatient management for low-risk nonvariceal upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. 2002; 55:1–5. PMID: 11756905.
Article
9. Lin HJ, Wang K, Perng CL, et al. Early or delayed endoscopy for patients with peptic ulcer bleeding. A prospective randomized study. J Clin Gastroenterol. 1996; 22:267–271. PMID: 8771420.
10. Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clin Gastroenterol Hepatol. 2009; 7:296.e1–302.e1. PMID: 19084483.
Article
11. Lee JG, Turnipseed S, Romano PS, et al. Endoscopy-based triage significantly reduces hospitalization rates and costs of treating upper GI bleeding: a randomized controlled trial. Gastrointest Endosc. 1999; 50:755–761. PMID: 10570332.
Article
12. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974; 2:394–397. PMID: 4136718.
Article
13. Kim KB, Yoon SM, Youn SJ. Endoscopy for nonvariceal upper gastrointestinal bleeding. Clin Endosc. 2014; 47:315–319. PMID: 25133117.
Article
14. Technology Assessment Committee. Chuttani R, Barkun A, et al. Endoscopic clip application devices. Gastrointest Endosc. 2006; 63:746–750. PMID: 16650531.
Article
15. Leung Ki EL, Lau JY. New endoscopic hemostasis methods. Clin Endosc. 2012; 45:224–229. PMID: 22977807.
Article
16. Hosoe N, Imaeda H, Kashiwagi K, et al. Clinical results of endoscopic hemostasis using a short transparent hood and short hemoclips for non-variceal upper gastrointestinal bleeding. Dig Endosc. 2009; 21:93–96. PMID: 19691781.
Article
17. Zepeda-Gómez S, Marcon NE. Endoscopic band ligation for nonvariceal bleeding: a review. Can J Gastroenterol. 2008; 22:748–752. PMID: 18818787.
Article
18. Watson JP, Bennett MK, Griffin SM, Matthewson K. The tissue effect of argon plasma coagulation on esophageal and gastric mucosa. Gastrointest Endosc. 2000; 52:342–345. PMID: 10968847.
Article
19. Nagata S, Kimura S, Ogoshi H, Hidaka T. Endoscopic hemostasis of gastric ulcer bleeding by hemostatic forceps coagulation. Dig Endosc. 2010; 22(Suppl 1):S22–S25. PMID: 20590766.
Article
20. Vergara M, Calvet X, Gisbert JP. Epinephrine injection versus epinephrine injection and a second endoscopic method in high risk bleeding ulcers. Cochrane Database Syst Rev. 2007; (2):CD005584. PMID: 17443601.
Article
21. Wu A. Arterial injection of adrenaline causing severe hypertension during emergency gastroscopy. Anaesth Intensive Care. 2013; 41:689. PMID: 23977929.
22. Tatsumi K, Uedo N, Ishihara R, et al. A water-jet videoendoscope may reduce operation time of endoscopic submucosal dissection for early gastric cancer. Dig Dis Sci. 2012; 57:2122–2129. PMID: 22451121.
Article
23. Dellon ES, Hawk JS, Grimm IS, Shaheen NJ. The use of carbon dioxide for insufflation during GI endoscopy: a systematic review. Gastrointest Endosc. 2009; 69:843–849. PMID: 19152906.
Article
24. ASGE Technology Committee. Tierney WM, Adler DG, et al. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc. 2009; 70:828–834. PMID: 19703691.
Article
25. Mori H, Kobara H, Fujihara S, et al. Accurate hemostasis with a new endoscopic overtube for emergency endoscopy. World J Gastroenterol. 2013; 19:2723–2726. PMID: 23674883.
Article
26. Sumiyama K, Rajan E. Endoscopic caps. Tech Gastrointest Endosc. 2006; 8:28–32.
Article
27. Warneke RM, Walser E, Faruqi S, Jafri S, Bhutani MS, Raju GS. Capassisted endoclip placement for recurrent ulcer hemorrhage after repeatedly unsuccessful endoscopic treatment and angiographic embolization: case report. Gastrointest Endosc. 2004; 60:309–312. PMID: 15278071.
Article
28. Kim JI, Kim SS, Park S, et al. Endoscopic hemoclipping using a transparent cap in technically difficult cases. Endoscopy. 2003; 35:659–662. PMID: 12929060.
Article
29. Isshi K, Tajiri H, Fujisaki J, et al. The effectiveness of a new multibending scope for endoscopic mucosal resection. Endoscopy. 2004; 36:294–297. PMID: 15057677.
Article
30. Bjorkman DJ, Zaman A, Fennerty MB, Lieberman D, Disario JA, Guest-Warnick G. Urgent vs. elective endoscopy for acute non-variceal upper-GI bleeding: an effectiveness study. Gastrointest Endosc. 2004; 60:1–8. PMID: 15229417.
Article
31. Church NI, Palmer KR. Diagnostic and therapeutic endoscopy. Curr Opin Gastroenterol. 1999; 15:504–508. PMID: 17023997.
Article
32. Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011; 60:1327–1335. PMID: 21490373.
Article
33. Beggs AD, Dilworth MP, Powell SL, Atherton H, Griffiths EA. A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding. Clin Exp Gastroenterol. 2014; 7:93–104. PMID: 24790465.
Article
34. Eriksson LG, Ljungdahl M, Sundbom M, Nyman R. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008; 19:1413–1418. PMID: 18755604.
Article
35. Loffroy R, Estivalet L, Cherblanc V, et al. Transcatheter embolization as the new reference standard for endoscopically unmanageable upper gastrointestinal bleeding. World J Gastrointest Surg. 2012; 4:223–227. PMID: 23467300.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr