• BLEEDING PEPTIC ULCER
• ENDOSCOPIC PROCEDURES
• GASTROINTESTINAL BLEEDING

• bleeding peptic ulcer
• endoscopic examination
• endoscopic hemostasis
• gastroduodenal ulcer bleeding
• upper gastrointestinal bleeding

• Humans
• Hemostasis, Endoscopic/methods
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/surgery
• Endoscopy, Gastrointestinal/methods
• Endoscopy, Gastrointestinal/standards
• Japan
• Peptic Ulcer Hemorrhage
• Practice Guidelines as Topic
• Societies, Medical

• Japan Gastroenterological Endoscopy Society (self-funded)

• Cyanoacrylate glue
• Forrest IIa and IIb
• Peptic ulcer hemorrhage

• Humans
• Female
• Male
• Retrospective Studies
• Cyanoacrylates/therapeutic use
• Cyanoacrylates/administration & dosage
• Peptic Ulcer Hemorrhage/therapy
• Adult
• Middle Aged
• Hemostasis, Endoscopic/methods
• Aged
• Treatment Outcome
• Recurrence
• Tissue Adhesives/therapeutic use
• Duodenal Ulcer/complications

• P-CAB
• endoscopic hemostasis
• hemostatic gel emulsion
• hemostatic powder spray
• peptic ulcer bleeding

• COVID‐19
• emergencies
• endoscopy
• gastrointestinal hemorrhage
• retrospective studies

• Adherent clot
• Endoscopic treatment
• Inverse probability of treatment weighting
• Medical treatment
• Peptic ulcer bleeding
• Rebleeding

• Humans
• Ulcer/complications
• Ulcer/therapy
• Hemostatics
• Retrospective Studies
• Peptic Ulcer Hemorrhage/etiology
• Endoscopy, Gastrointestinal/adverse effects
• Hemostasis, Endoscopic/adverse effects
• Peptic Ulcer/complications
• Recurrence

• GI bleeding
• General surgery

• Female
• Humans
• Gallbladder/diagnostic imaging
• Choledocholithiasis/complications
• Choledocholithiasis/diagnostic imaging
• Choledocholithiasis/surgery
• Cholecystitis/complications
• Cholecystitis/surgery
• Gallbladder Diseases/complications
• Hemorrhage/complications

• Humans
• Duodenal Ulcer/complications
• Duodenal Ulcer/surgery
• Duodenum
• Hemorrhage
• Peptic Ulcer Hemorrhage/surgery

• Bleeding
• endoscopic cyanoacrylate injection
• endoscopic therapy
• peptic ulcer
• rebleeding

• Humans
• Retrospective Studies
• Peptic Ulcer Hemorrhage/therapy
• Cyanoacrylates
• Hemostatics
• Peptic Ulcer

• balloon enteroscopy
• double-balloon enteroscopy
• small intestine

In monotherapy studies for bleeding peptic ulcers, large volumes of epinephrine were associated with a reduction in rebleeding. However, the impact of epinephrine volume in patients treated with combination endoscopic therapy remains unclear.

To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or clipping.

Data from 132 patients with Forrest class Ia, Ib, and IIa peptic ulcers were reviewed. The primary outcome was further bleeding at 7 d; secondary outcomes included further bleeding at 30 d, need for additional therapeutic interventions, post-endoscopy blood transfusions, and 30-day mortality. Logistic and linear regression and Cox proportional hazards analyses were performed.

There was no association between epinephrine volume and all primary and secondary outcomes in multivariable analyses. Increased odds for further bleeding at 7 d occurred in patients with elevated creatinine values (aOR 1.96, 95%CI 1.30-3.20; P < 0.01) or hypotension requiring vasopressors (aOR 6.34, 95%CI 1.87-25.52; P < 0.01). Both factors were also associated with all secondary outcomes.

Epinephrine maintains an important role in the management of bleeding ulcers, but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic therapy. Further bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of epinephrine. However, in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable, it is conceivable that increased volumes of epinephrine may still be beneficial.

• Peptic ulcer disease
• Gastrointestinal bleeding
• Upper endoscopy
• Endoscopic hemostasis
• Epinephrine

• Epinephrine injection monotherapy
• Nomogram
• Peptic ulcer bleeding
• Rebleeding
• Risk factors

• Epinephrine/therapeutic use
• Hemostasis
• Hemostasis, Endoscopic/adverse effects
• Humans
• Nomograms
• Peptic Ulcer Hemorrhage/drug therapy
• Recurrence
• Retrospective Studies
• Risk Factors
• Stomach Ulcer/complications

• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province
• 20212BDH81019 Science and Technology Department of Jiangxi Province

• Clipping
• Digestive endoscopy
• Endoclips
• Gastrointestinal bleeding
• Over-the-scope clip

• Endoscopia
• Endoscopy
• Gastrointestinal bleeding
• Hemorragia gastrointestinal
• Mortalidad
• Mortality

• Glasgow-Blatchford
• Helicobacter pylori
• NSAIDs
• PPI
• antithrombotic management
• capsule endoscopy
• colonic bleeding
• diverticular bleeding
• endoscopic therapy
• gastrointestinal bleeding
• peptic ulcer bleeding
• small bowel bleeding

• Endoscopy, Gastrointestinal
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic
• Humans

Endoscopic clipping has become a common practice among endoscopists. Several models are available, most frequently being introduced via the working channel of the endoscope (through-the-scope); however, larger clips can also be mounted onto the distal tip of the endoscope (over-the-scope). The main indications for endoclip placement include providing effective mechanical hemostasis for bleeding lesions and allowing endoscopic closure of gastrointestinal perforations. Endoclips can also be used prophylactically after endoscopic resection; however, this practice is still controversial. This review discusses the main indications for endoscopic clipping in the esophagus, stomach, duodenum and colon to manage acute bleeding lesions, and the criteria to be used in the prevention of delayed post-polypectomy bleeding.

• Endoclip
• gastrointestinal bleeding
• mechanical hemostasis
• post-polypectomy
• prophylaxis

• Endoscopic hemostasis
• Gastrointestinal bleeding
• Hemospray
• Randomized controlled trial

• Duodenal Ulcer/complications
• Female
• Hemostasis, Endoscopic/adverse effects
• Hemostasis, Endoscopic/methods
• Hemostatics/administration & dosage
• Hemostatics/adverse effects
• Humans
• Male
• Middle Aged
• Minerals/administration & dosage
• Minerals/adverse effects
• Peptic Ulcer Hemorrhage/etiology
• Peptic Ulcer Hemorrhage/pathology
• Peptic Ulcer Hemorrhage/surgery
• Powders/administration & dosage
• Powders/adverse effects
• Recurrence
• Reoperation/statistics & numerical data
• Stomach Ulcer/complications
• Treatment Outcome

• Endoscopic diagnostics
• Endovascular treatment
• Intervention
• Recurrent bleeding risk
• Surgery

• Anticoagulants
• Antiplatelet
• Doppler endoscopic ultrasound
• Endoscopic therapy
• Hemospray®
• Ovesco
• Peptic ulcer
• Second-look
• Upper gastrointestinal bleeding

• Adult
• Aged
• Aged, 80 and over
• Duodenal Ulcer/complications
• Duodenal Ulcer/therapy
• Endoscopy, Digestive System/methods
• Female
• Hemostasis, Endoscopic/methods
• Humans
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage/etiology
• Peptic Ulcer Hemorrhage/therapy
• Recurrence
• Surgical Instruments
• Time Factors

Although upper gastrointestinal bleeding is usually segregated from lower gastrointestinal bleeding, and guidelines for gastrointestinal bleeding are divided into two separate sections, they may not be distinguished from each other in clinical practice. Most patients are first observed with signs of bleeding such as hematemesis, melena, and hematochezia. When a patient with these symptoms presents to the emergency room, endoscopic diagnosis and treatment are considered together with appropriate initial resuscitation. Especially, in cases of variceal bleeding, it is important for the prognosis that the endoscopy is performed immediately after the patient stabilizes. In cases of suspected lower gastrointestinal bleeding, full colonoscopy after bowel preparation is effective in distinguishing the cause of the bleeding and treating with hemostasis. The therapeutic aspect of endoscopy, using the mechanical method alone or injection with a certain modality rather than injection alone, can increase the success rate of bleeding control. Therefore, it is important to consider the origin of bleeding and how to approach it. In this article, we aim to review the role of endoscopy in diagnosis, treatment, and prognosis in patients with acute gastrointestinal bleeding in a real clinical setting.

• Endoscopy
• Gastrointestinal bleeding
• Endoscopic bleeding control
• Emergency bowel preparation
• Bedside endoscopy
• Second-look endoscopy

• Chronic Disease
• Combined Modality Therapy
• Electrocoagulation
• Epinephrine/therapeutic use
• Hemostasis, Endoscopic/methods
• Humans
• Male
• Middle Aged
• Peptic Ulcer Hemorrhage/therapy
• Stomach Ulcer/therapy
• Vasoconstrictor Agents/therapeutic use

• Clinical Trial
• Comparison
• STING Study
• Stomach

To evaluate rebleeding, primary failure (PF) and mortality of patients in whom over-the-scope clips (OTSCs) were used as first-line and second-line endoscopic treatment (FLET, SLET) of upper and lower gastrointestinal bleeding (UGIB, LGIB).

A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016 (n = 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.

Primary hemostasis and clinical success of bleeding lesions (without rebleeding) was achieved in 88/100 (88%) and 78/100 (78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET (4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET (OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7 (35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.

Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.

• Gastrointestinal bleeding
• Rockall risk score
• Over-the-scope clip
• First-line endoscopic treatment
• Second-line endoscopic treatment

• Adult
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Databases, Factual
• Endoscopes, Gastrointestinal
• Equipment Design
• Female
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/mortality
• Gastrointestinal Hemorrhage/surgery
• Germany
• Hemostasis, Endoscopic/adverse effects
• Hemostasis, Endoscopic/instrumentation
• Hemostasis, Endoscopic/mortality
• Hospital Mortality
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Recurrence
• Retrospective Studies
• Risk Factors
• Treatment Failure
• Young Adult

Although resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure in hemorrhagic shock, this intervention is associated with high mortality and may represent a last-ditch option for trauma patients. We conducted a retrospective study of patients with nonvariceal upper gastrointestinal bleeding (UGIB) who underwent REBOA to identify the effectiveness of REBOA and reviewed published literatures.

REBOA were performed by trained acute care physicians in the emergency room and intensive care unit. The deployment of balloon catheters was positioned using ultrasonography guidance. Collected data included clinical characteristics, hemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality. A literature search using PUBMED to include “aortic occlusion” and “gastrointestinal bleeding” was conducted.

REBOA was attempted in eight patients among 140 patients with UGIB and median age was 66 years. Systolic blood pressure significantly increased after REBOA (66 ± 20 vs. 117 ± 45 mmHg, p < 0.01) and the total occlusion time of REBOA was 80 ± 48 min. Strong positive correlations were found between total occlusion time of REBOA and lactate concentration (Spearman’s r=0.77), clinical Rockwall score (Spearman’s r=0.80), and age (Spearman’s r=0.88), respectively.

REBOA can be performed with a high degree of technical success and is effective at improving hemodynamic in patients with UGIB. Correlations between total occlusion time and high lactate levels, clinical Rockall score, and age may be important for successful use of REBOA.

Haemorrhagic shock is a major cause of death in the acute care setting. Since 2009, our emergency department has used intra-aortic balloon occlusion (IABO) catheters for resuscitative endovascular balloon occlusion of the aorta (REBOA).

REBOA procedures were performed by one or two trained acute care physicians in the emergency room (ER) and intensive care unit (ICU). IABO catheters were positioned using ultrasonography. Collected data included clinical characteristics, haemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality.

Subjects comprised 25 patients (trauma, n = 16; non-trauma, n = 9) with a median age of 69 years and a median shock index of 1.4. REBOA was achieved in 22 patients, but failed in three elderly trauma patients. Systolic blood pressure significantly increased after REBOA (107 vs. 71 mmHg, p < 0.01). Five trauma patients (20 %) died in ER, and mortality rates within 24 h and 60 days were 20 % and 12 %, respectively. No REBOA-related complications were encountered. The total occlusion time of REBOA was significantly lesser in survivors than that in non-survivors (52 vs. 97 min, p < 0.01). Significantly positive correlations were found between total occlusion time of REBOA and shock index (Spearman’s r = 0.6) and lactate concentration (Spearman’s r = 0.7) in survivors.

REBOA can be performed in ER and ICU with a high degree of technical success. Furthermore, correlations between occlusion time and initial high lactate levels and shock index may be important because prolonged occlusion is associated with a poorer outcome.