ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-Session 1 Presentation 1

Video Transcription

Video Summary

In this video lecture, Dr. Alan Barkin discusses new tools for non-variceal upper GI bleeding. He focuses on two main modalities: endoscopically applied hemostatic topical products, such as hemo spray, and cap-mounted clips, particularly over the scope clips. Dr. Barkin explains that conventional endoscopic therapy can fail in 15% of cases, leading to the emergence of newer modalities. He discusses the various options available, including bipolar electrocoagulation, heater probe, injection of absolute ethanol, through the scope clips, argon plasma coagulation, and monopolar electrocoagulation for GRASPR. Dr. Barkin highlights the advantages and limitations of each modality and presents data on their efficacy and safety. He also emphasizes the importance of optimizing the endoscopic setting and collaborating with colleagues in challenging cases. While these new tools show promise in improving outcomes for patients with refractory and malignant bleeding, there is still uncertainty about their optimal use in different clinical contexts. Dr. Barkin suggests that guidelines will likely recommend using topical agents and cap-mounted clips for rescue and possibly even first-line treatment. However, cost-effectiveness issues remain poorly addressed.

Asset Subtitle

Alan N. Barkun, MD, FASGE

Keywords

non-variceal upper GI bleeding

endoscopically applied hemostatic topical products

cap-mounted clips

conventional endoscopic therapy

refractory and malignant bleeding