Which endoscopic techniques are used in the treatment of upper gastrointestinal bleeding (UGIB)?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

There are several currently widely accepted hemostatic treatment options. These include injection of epinephrine and tissue adhesives such as cyanoacrylate, ablative therapy with contact modalities such as thermal coagulation with heater probe and bipolar hemostatic forceps, noncontact modalities such as hemostatic power sprays and argon plasma coagulation, and mechanical hemostasis with band ligation, endoscopic hemoclips, and over-the-scope clips.

The following endoscopic techniques have been developed for achieving hemostasis [10] :

  • Injection of epinephrine or sclerosants
  • Bipolar electrocoagulation
  • Band ligation [53]
  • Heater probe coagulation
  • Constant probe pressure tamponade
  • Bipolar/soft coagulation hemostatic forceps
  • Argon plasma coagulator (APC)
  • Laser photocoagulation
  • Rubber band ligation
  • Application of hemostatic materials, including biologic glue and tissue adhesives
  • Application of hemoclips/endoclips or over-the-scope clips
  • Application of hemostatic powder/spray [54]
  • Doppler ultrasonographic assessment, pre- and postendotherapy

Treatment using a combination of endoscopic therapies has become more common. For example, injection therapy can be applied first to better clarify the bleeding site with at least partial hemostasis, especially in the actively bleeding patient, followed by the application of heater probe or bipolar (gold) probe coagulation with coaptation for definitive hemostatic management. Injection therapy can also be performed prior to endoscopic placement of hemoclips.

According to the 2008 Scottish Intercollegiate Guidelines Network (SIGN) guideline, combinations of endoscopy with an injection of at least 13 mL of 1:10,000 adrenaline, coupled with either a thermal or mechanical treatment, are more effective than single modalities. [35]

The 2010 international consensus guidelines on UGIB recommended the use of endoscopic clips or thermal therapy for high-risk lesions. [52]


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