Christodoulidis G, Tsagkidou K, Bartzi D, Prisacariu IA, Agko ES. Endoscopic management of upper non-variceal and lower gastrointestinal bleeding: Where do we stand? World J Gastrointest Endosc 2025; 17(5): 105580 [DOI: 10.4253/wjge.v17.i5.105580]
Corresponding Author of This Article
Grigorios Christodoulidis, MD, PhD, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. May 16, 2025; 17(5): 105580 Published online May 16, 2025. doi: 10.4253/wjge.v17.i5.105580
Endoscopic management of upper non-variceal and lower gastrointestinal bleeding: Where do we stand?
Grigorios Christodoulidis, Kyriaki Tsagkidou, Dimitra Bartzi, Ioana Alexandra Prisacariu, Eirini Sara Agko
Grigorios Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Kyriaki Tsagkidou, Department of Gastroenterology, University Hospital of Larisa, Larisa 41100, Greece
Dimitra Bartzi, Department of Oncology, The 251 Airforce General Hospital, Athens 11525, Greece
Ioana Alexandra Prisacariu, Department of Rehabilitation, Luzerner Kantonsspital Wolhusen, Lucerne 6110, Luzern, Switzerland
Eirini Sara Agko, Department of Intensive Care Unit, Asklepios Paulinen Clinic Wiesbaden, Wiesbaden 65197, Germany
Co-first authors: Grigorios Christodoulidis and Kyriaki Tsagkidou.
Author contributions: Christodoulidis G and Tsagkidou K contribute equally to this study as co-first authors; Christodoulidis G, Tsagkidou K, Bartzi D and Agko ES contributed to this paper; Christodoulidis G designed the overall concept and outline of the manuscript; Christodoulidis G, Tsagkidou K, Bartzi D and Agko ES contributed to the discussion and design of the manuscript; Christodoulidis G, Tsagkidou K, Bartzi D, Prisacariu IA and Agko ES contributed to the writing, editing the manuscript, and review of literature.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Grigorios Christodoulidis, MD, PhD, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: January 30, 2025 Revised: March 24, 2025 Accepted: April 21, 2025 Published online: May 16, 2025 Processing time: 104 Days and 8.5 Hours
Abstract
Non-variceal upper gastrointestinal bleeding (GIB) remains a significant clinical challenge with a 30-day mortality of up to 11%. Peptic ulcers are the most common cause, followed by other conditions like Mallory-Weiss syndrome, Dieulafoy’s lesions, and gastric neoplasms. Treatment strategies include acid-suppressive therapy, endoscopic interventions, and surgical or radiological procedures. Endoscopic techniques such as over-the-scope clips, coagulation graspers, and endoscopic ultrasound-guided treatments have significantly improved outcomes, reducing rebleeding rates and the need for surgery. Injectable therapies, mechanical hemostasis via clips, and thermal modalities (e.g., electrocoagulation, argon plasma coagulation) remain standard approaches for active bleeding. Newer hemostatic powders, such as TC-325, offer promising non-contact treatments, particularly in cases of refractory bleeding or malignancy. Doppler endoscopic probes aid in risk stratification by detecting residual arterial blood flow, improving the efficacy of endoscopic therapy and reducing rebleeding risks. For small bowel bleeding, endoscopic management with enteroscopy and thermal therapies remains key, though medical therapies are evolving. Lower GIB, which often involves conditions like diverticular disease and angioectasia, requires a comprehensive approach combining endoscopic, radiologic, and surgical interventions. Pharmacologic management focuses on balancing antithrombotic therapy with bleeding risks, with reversal agents playing a crucial role in life-threatening bleeding episodes. This review highlights advances in diagnostic tools and endoscopic therapies that have enhanced management outcomes for GIB across various etiologies.
Core Tip: Gastrointestinal bleeding (GIB) is a serious condition requiring prompt diagnosis and intervention. Advances in endoscopic therapy, such as clips, thermocoagulation, and hemostatic powders, have improved outcomes by reducing rebleeding, surgeries, and mortality. Non-variceal upper GIB, often caused by peptic ulcers, has a 30-day mortality of 11%, while lower GIB, with diverse causes like diverticular bleeding and ischemic colitis, usually resolves spontaneously but can recur. Accurate diagnosis, early treatment, and careful management are essential to improve outcomes and reduce complications.
