Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding: A review

Abstract

Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and non-variceal gastrointestinal bleeding. Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally. It is associated with high mortality, morbidity, and cost of the health care system. Despite the continuous improvement of therapeutic endoscopy, the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue. Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection, argon plasma coagulation, heater probe, and placement of through the scope clip, which can be used alone or in combination to decrease the risk of rebleeding. Recently, more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis. This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip, Coagrasper, hemostatic sprays, radiofrequency ablation, cryotherapy, endoscopic suturing devices, and endoscopic ultrasound-guided angiotherapy. In this review article, we will also discuss the technical aspects of the common procedures, outcomes in terms of safety and efficacy, and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.

Keywords: Non-variceal upper gastrointestinal bleeding, Over the scope clip, Hemospray, Radiofrequency ablation, Endoscopic suturing device

Core tip: In the last two decades, there has been drastic decline in the mortality and morbidity caused non-variceal upper gastrointestinal bleeding due to significant progress in the therapeutic endoscopy. The use of devices such as over the scope clips system, Coagrasper, hemospray and endoscopic suturing has tremendously evolved and expanded to achieve hemostasis as a primary method or when conventional therapeutic devices such as heater probe, hemoclips or epinephrine injection fails to control bleeding.