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

• Muguruma N
• Kitamura S
• Kimura T
• Miyamoto H
• Takayama T

• KMID: 1801198
• DOI: http://doi.org/10.5946/ce.2015.48.2.96

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.

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