ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (On-demand) | May 2023-Barkun

Barkun_New tools for Non-Variceal UGI Bleeding

Pdf Summary

This document discusses new tools and modalities for treating non-variceal upper gastrointestinal (UGI) bleeding. The mortality rate for non-variceal UGI bleeding has decreased over the years, with endoscopic hemostasis being the cornerstone of therapy. However, conventional endoscopic therapy can fail in achieving hemostasis in some patients. Therefore, new modalities are being explored.<br /><br />One modality is the use of hemostatic topical products, such as Tc325 (Hemospray), which forms a mechanical "tamponade" to stop active bleeding at the site. Another modality is the use of cap-mounted over-the-scope clips, which are used for patients who develop recurrent bleeding due to ulcers after previous successful endoscopic hemostasis.<br /><br />Timing of endoscopy is also discussed, with a randomized controlled trial showing that there was no significant difference in mortality or further bleeding at 30 days between patients who underwent endoscopy within 6 hours (urgent) or within 6-24 hours (early).<br /><br />The document also provides recommendations on how to treat patients with peptic ulcer bleeding at endoscopy, including the use of bipolar electrocoagulation, heater probe, injection of absolute ethanol, through-the-scope clips, argon plasma coagulation, soft monopolar electrocoagulation, and epinephrine injection in combination with another hemostatic modality.<br /><br />The use of hemostatic powders and gels, such as Tc-325, is suggested for endoscopic hemostatic therapy in patients with actively bleeding ulcers. However, the cost of Tc-325 may be prohibitive in some countries.<br /><br />The use of these new tools and modalities is discussed in the context of refractory lesions, predictors of rebleeding, malignant bleeding, and the effectiveness of over-the-scope clips. The document also highlights the need for optimized patient selection and the importance of collaboration with colleagues in refractory cases.<br /><br />Overall, these new tools and modalities show promise in improving outcomes for patients with non-variceal UGI bleeding, but further research is needed to better understand their roles and cost-effective implications.

Keywords

non-variceal UGI bleeding

endoscopic hemostasis

hemostatic topical products

Tc325

cap-mounted over-the-scope clips

timing of endoscopy

peptic ulcer bleeding

bipolar electrocoagulation

hemostatic powders and gels

refractory lesions