Clin Endosc.  2016 Sep;49(5):421-424. 10.5946/ce.2016.110.

Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding

Affiliations
  • 1Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA. jangs@ccf.org

Abstract

Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

Keyword

Endoscopy; Hemostasis; Peptic ulcer; Embolization, therapeutic; Gastrointestinal hemorrhage

MeSH Terms

Argon Plasma Coagulation
Catheter Ablation
Cautery
Cryotherapy
Drug Therapy
Embolization, Therapeutic
Endoscopy
Epinephrine
Gastrointestinal Hemorrhage
Hemorrhage*
Hemostasis
Incidence
Lysine
Mortality
Peptic Ulcer
Proton Therapy
Tranexamic Acid
Epinephrine
Lysine
Tranexamic Acid

Reference

1. Tielleman T, Bujanda D, Cryer B. Epidemiology and risk factors for upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2015; 25:415–428.
Article
2. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc. 2015; 81:882–888. e1.
Article
3. Lam KL, Wong JC, Lau JY. Pharmacological treatment in upper gastrointestinal bleeding. Curr Treat Options Gastroenterol. 2015; 13:369–376.
Article
4. Leontiadis GI, Sharma VK, Howden CW. Proton pump inhibitor therapy for peptic ulcer bleeding: Cochrane collaboration meta-analysis of randomized controlled trials. Mayo Clin Proc. 2007; 82:286–296.
Article
5. Neumann I, Letelier LM, Rada G. Comparison of different regimens of proton pump inhibitors for acute peptic ulcer bleeding. Cochrane Database Syst Rev. 2013; (6):CD007999.
Article
6. Bennett C, Klingenberg SL, Langholz E, Gluud LL. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2014; (22):CD006640.
Article
7. Fortinsky KJ, Bardou M, Barkun AN. Role of medical therapy for nonvariceal upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2015; 25:463–478.
Article
8. Roberts I, Coats T, Edwards P, et al. HALT-IT: tranexamic acid for the treatment of gastrointestinal bleeding: study protocol for a randomised controlled trial. Trials. 2014; 15:450.
Article
9. Bergel S. The effect of the fibrin. Dtsch Med Wochenschr. 1909; 35:663–5.
10. Hemospray. A different approach to hemostasis [Internet]. Bloomington: Cook Medical;c2016. [cited 2016 Sep 13]. Available from: http://hemospray.cookmedical.com/region-two/hemostasis-treatment.html.
11. Yau AH, Ou G, Galorport C, et al. Safety and efficacy of Hemospray(R) in upper gastrointestinal bleeding. Can J Gastroenterol Hepatol. 2014; 28:72–76.
12. Chen YI, Barkun AN. Hemostatic powders in gastrointestinal bleeding: a systematic review. Gastrointest Endosc Clin N Am. 2015; 25:535–552.
13. Müller-Cerbes D, Beeck A, Dormann A, et al. Hemostasis with powder: experience with EndoClot in difficult Upper GI bleedings. Endosk heute. 2013; 26:254–258.
14. Halkerston K, Evans J, Ismail D, et al. Early clinical experience of Endoclot in the treatment of acute gastro-intestinal bleeding. Gut. 2013; 62(Suppl 1):A149.
15. Kurt M, Onal I, Akdogan M, et al. Ankaferd blood stopper for controlling gastrointestinal bleeding due to distinct benign lesions refractory to conventional antihemorrhagic measures. Can J Gastroenterol. 2010; 24:380–384.
Article
16. 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.
Article
17. Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009; 7:33–47.
Article
18. Manta R, Galloro G, Mangiavillano B, et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc. 2013; 27:3162–3164.
Article
19. McGorisk T, Krishnan K, Keefer L, Komanduri S. Radiofrequency ablation for refractory gastric antral vascular ectasia (with video). Gastrointest Endosc. 2013; 78:584–588.
Article
20. Dray X, Repici A, Gonzalez P, et al. Radiofrequency ablation for the treatment of gastric antral vascular ectasia. Endoscopy. 2014; 46:963–969.
21. Cho S, Zanati S, Yong E, et al. Endoscopic cryotherapy for the management of gastric antral vascular ectasia. Gastrointest Endosc. 2008; 68:895–902.
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