How is a specific endoscopic treatment selected for upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

The choice of treatment modality is influenced by the size of the vessel. Animal studies have demonstrated that the heater probe and bipolar probe are effective for vessels as large as 2 mm in diameter.

Other techniques (eg, clips, band ligation) or a combination of techniques are needed for larger vessels or vessels that are not approachable by the heater probe or bipolar probe. (Surgical intervention should be considered when dealing with vessels larger than 2 mm in diameter, discounting an enlargement due to the development of a pseudoaneurysm.) The over-the-scope clips are able to grasp larger areas and apply more mechanical force to larger vessels, making them an option when standard endoclips may not suffice.

It is important to remember when planning endoscopic therapy for a large vessel, that the 7-French heater probe or gold probe catheter can traverse the accessory channel of a standard adult upper endoscope, but a therapeutic endoscope with a larger accessory channel is necessary to pass a 10-French thermal probe.


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