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
|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.
Adapted from Laine L, et al. Clin Gastroenterol Hepatol 2009;7:33–47.