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What are the endoscopic techniques for managing nonvariceal UGI bleeding?
- There are a number of endoscopic modalities available for the treatment of nonvariceal UGI bleeding.
- Epinephrine therapy is not effective as monotherapy but can be a helpful adjuvant in combination with other modalities.
- In general, the choice of therapy depends on the type and location of the lesion and the expertise of the endoscopist.
Endoscopic Techniques for the Management of Nonvariceal Bleeding
| Technique | Usage |
|---|---|
| Epinephrine (1:10,000) injected in four quadrants around the lesion | Not effective as monotherapy for hemostasis; effective in combination with another endoscopic technique |
| Thermal contact therapy (bipolar probes, heater probes) | Decrease further bleeding, need for surgery, and mortality |
| Endoclip | Decrease bleeding and need for surgery |
| Sclerosant (e.g., absolute alcohol, 5% ethanolamine) | Risk of tissue necrosis; decrease further bleeding, need for surgery, and mortality |
| Other: APC, Nd:YAG laser, monopolar thermal probe, thrombin/ fibrin glue | Not first-line (limited data, less availability, cost issues) |
| Hemospray | Newer modality, limited data suggest utility in massive bleeding to achieve initial control, as an adjunct to standard therapy in high-risk lesions and in tumor bleeding |
APC, Argon plasma coagulation; Nd:YAG: neodymium-doped yttrium aluminum garnet.
Sources
Adapted from Laine L, et al. Clin Gastroenterol Hepatol 2009;7:33–47.
