Therapeutic Endoscopy for Nonvariceal Gastrointestinal Bleeding

Abstract

The evaluation and management of acute gastrointestinal bleeding in infants, children, and adolescents is a reason for emergency consultation frequently cited by pediatric gastroenterologists. After stabilization of the patient's condition, endoscopic evaluation remains the most rapid and accurate method to identify the origin of acute bleeding in the majority of lesions in the pediatric age group. Several endoscopic techniques may be applied to bleeding lesions to achieve hemostasis. Familiarity with the various techniques and with the specifics of their use is essential for the pediatric endoscopist. This review focuses on the endoscopic management of acute nonvariceal bleeding in infants and children.

Endoscopic Hemostasis for Bleeding Gastric Ulcer Caused by Ibuprofen in a 16-month-old Infant

“…Monopolar electrocautery means that the electrical circuit runs through the patient body to a grounding pad placed on the patient [27]. In electrocoagulation, the electric energy is converted to heat energy within the target tissue, which coagulates the tissue, causing collagen contraction and vessel shrinkage [25]. A review of electrocautery suggested using coagulation at a setting of 20 Watts for hot snaring [28].…”

“…Thus, a Dieulafoy's lesion could be excluded in that an oozing vessel with surrounding mucosal ulcer was revealed on an EGD in this patient. Endoscopic hemostatic therapy for bleeding peptic ulcer includes injection methods (normal saline, vasoconstrictor as epinephrine, sclerotherapeutic agents, thrombin cocktail, or combination therapy), coagulation (monopolar, bipolar electrocoagulation, contact thermal methods using heater probe, and noncontact thermal methods using argon plasma), and a mechanical method using hemostatic clips [25,26]. An additional coagulation devices are the hot biopsy forceps and the polypectomy snares.…”

Modern Methods of Endoscopic Diagnostics and Treatment for Upper Gastrointestinal Tract Diseases in Pediatrics

“…Значительные кровотечения из пищеварительно-го тракта у детей редки, и вместе с тем они могут нести существенную угрозу для жизни ребенка [21]. Причиной геморрагии могут быть различные дефекты целостности слизистой оболочки, ее сосудистые маль-формации, новообразования и варикозное расширение вен [2].…”

“…Эндоскопические гемостатические процедуры вклю-чают инъекции медикаментов, термальную коагуляцию, лигирование и клипирование источника кровотечения [21]. Самой распространенной методикой эндоскопиче-ского гемостаза кровоточащих язв, особенно у малень-ких детей, является инъекционная терапия.…”

Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

“…Medical agents (proton pump inhibitors or antacids) are appropriate for most nonvariceal UGB cases, but endoscopic management is needed in some cases, especially with active bleeding or patients with high-risk stigmata for rebleeding. Injection, coagulation/thermal therapy, laser therapy, and hemoclip application are the most commonly used endoscopic techniques for nonvariceal UGB (7). The usage of these techniques depends on equipment availability and experience of the endoscopists.…”