On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (On-Demand) | 2026-Case/Video-based non-variceal hemostasis session with panel

Video Transcription

Video Summary

The speakers discuss practical management of difficult upper-GI bleeding cases, especially actively bleeding duodenal ulcers. A clear cap can help tamponade bleeding, stabilize the view, and position instruments. Treatment may include epinephrine followed by thermal therapy with a bipolar probe or hemostatic forceps; clinicians emphasize using water to release the probe safely and allowing time for cooling. Antithrombotic use alone is not considered a reason to avoid thermal treatment.<br /><br />For persistent bleeding, repeated cautery must be balanced against tissue injury and perforation risk. Over-the-scope clips (OTSCs) can treat selected lesions and may also mark a site for interventional radiology (IR), but fibrotic tissue can be difficult to capture, and incorrect deployment can worsen bleeding. If endoscopic control fails, prepare backup equipment and contact IR early. A large-clot suction system can clear gastric clots and reveal lesions such as Dieulafoy lesions.<br /><br />The discussion also covers recognizing pseudoaneurysms, which should generally be referred to IR rather than treated endoscopically, and managing perforation with an OTSC when needed. Routine repeat endoscopy or CT imaging is not recommended without clinical indications.

Asset Subtitle

Michelle Hughes and Andy Tau Q&A

Keywords

upper-GI bleeding

duodenal ulcer

hemostatic forceps

thermal therapy

over-the-scope clip

interventional radiology

Dieulafoy lesion

pseudoaneurysm

clear cap