New and old methods for endoscopic control of nonvariceal upper gastrointestinal bleeding.
Candidates for endoscopic therapy of nonvariceal upper gastrointestinal bleeding include patients with bleeding ulcers, Mallory-Weiss tears, angiodysplasia, and Dieulafoy or other lesions with active bleeding, non-bleeding visible vessel, or adherent clot. Continuous infusion of intravenous proton pump inhibitors lowers rebleeding risk after endoscopic therapy. Of standard methods, a combination of epinephrine injection with thermal coagulation (bipolar or heater probe) has been shown to be optimal, with lower rebleeding rates (5-10%) than for either method alone. Endoscopic clipping is an appealing technique, but comparative data with other methods are limited and conflicting. Band ligation is also suitable for many non-ulcer lesions without a firm base. Argon plasma coagulation is most useful for lesions with a large surface area such as watermelon stomach, but of uncertain advantage for other nonvariceal bleeding lesions. Regardless of method used, technical expertise plays a role in the outcomes of therapy. Of future interest are techniques to image beneath the surface and predict rebleeding risk, and improved methods of mechanical hemostasis.
Freeman
Martin L
ML
University of Minnesota, Division of Gastroenterology, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
D000925:Anticoagulants / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods; D006801:Humans
D000925:Anticoagulants