Interventional endoscopic treatment of upper gastrointestinal bleeding - when, how, and how often

Abstract

Acute upper gastrointestinal (GI) bleeding is still associated with high mortality. Reducing the rebleeding rate is the major challenge in therapeutic endoscopy. The following article describes the indications, techniques and limitations of endoscopic treatment of upper GI bleeding. Endoscopic techniques such as endoscopic sclerotherapy (EIS), endoscopic variceal ligation (EVL), cyanoacrylate obliteration, argon plasma coagulation (APC), and the application of hemoclip are described and compared concerning their efficacy. The pros and cons of "second-look" endoscopy are discussed.

The use of laparoscopy in abdominal emergencies

“…Currently, most bleeding ulcers can be controlled endoscopically [21]. The few patients who still require operative control usually are sick and hemodynamically unstable.…”

Endoscopy for the General Surgeon

“…Traditional sclerotherapy is giving way to endoscopic rubberband ligation of esophageal varices. Equal rates of hemorrhage control have been shown with banding and sclerotherapy, and banding has a lower incidence of stricture formation [11]. The banding device has multiple preloaded rubber bands that are released by a trigger after the mucosa has been sucked into the scope, thereby strangling the superficial venous vessels that thrombose and slough (Fig.…”

Beneficial effects of living-donor liver transplantation on esophageal varices

“…5 Sclerotherapy is widely used as the fi rst-line treatment for acute bleeding because it provides control of hemorrhage in more than 90% of cases, with a rate of rebleeding of 15.5%-34.4%. 6 Shunt surgery, including a transjugular intrahepatic portosystemic shunt, is effective in reducing the risk of rebleeding, but carries the risk of precipitating or exacerbating encephalopathy. 7 Liver transplantation (LT) should be considered for all patients with end-stage hepatic failure, as it not only deals with acute variceal hemorrhage but also restores normal portal circulation.…”