Acute nonvariceal upper gastrointestinal bleeding is a common medical emergency with associated morbidity and mortality. Patients with significant bleeding should be started on proton pump inhibitor infusion. Upper endoscopy after adequate resuscitation is required for most patients and should be performed within 24 hours of presentation. Endoscopic hemostasis is less invasive and is the preferred method for the treatment of upper gastrointestinal bleeding in most circumstances. Different methods of endoscopic interventions include injection therapy, thermal coagulation, or mechanical therapy. Endoscopic management of nonvariceal upper gastrointestinal bleeding has been shown to improve clinical outcomes, with significant reduction of recurrent bleeding, need of surgery, and mortality. Recently, newly developed endoscopic apparatuses have been used for hemostasis with greater safety and efficiency.
Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Methods ; Mortality ; Proton Pumps ; Resuscitation

Diverticular bleeding accounts for approximately 26%–40% of the cases of lower gastrointestinal bleeding. Rupture of the vasa recta at the neck or dome of the diverticula can be the cause of this bleeding. Colonoscopy aids in not only the diagnosis but also the treatment of diverticular bleeding after a steady bowel preparation. Endoscopic hemostasis involves several methods, such as injection/thermal contact therapy, clipping, endoscopic band ligation (EBL), hemostatic powder, and over-the-scope clips. Each endoscopic method can provide a secure initial hemostasis. With regard to the clinical outcomes after an endoscopic treatment, the methods reportedly have no significant differences in the initial hemostasis and early recurring bleeding; however, EBL might prevent the need for transcatheter arterial embolization or surgery. In contrast, the long-term outcomes of the endoscopic treatments, such as a late bleeding and recurrent bleeding at 1 and 2 years, are not well known for diverticular bleeding. With regard to a cure for diverticular bleeding, there should be an improvement in both the endoscopic methods and the multilateral perspectives, such as diet, medicines, interventional approaches, and surgery.
Colon ; Colonoscopy ; Diagnosis ; Diet ; Diverticulum ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Neck ; Rupture

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Electrocoagulation ; Endoscopes ; Epinephrine ; Fibrin Tissue Adhesive ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Peptic Ulcer ; Shock ; Sphincterotomy, Endoscopic

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Diagnosis ; Electrocoagulation ; Endoscopes ; Epinephrine ; Fibrin Tissue Adhesive ; Hemobilia ; Hemodynamics ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Peptic Ulcer ; Shock ; Sphincterotomy, Endoscopic

Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.
Angiography ; Embolization, Therapeutic/*methods ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/etiology/*therapy ; Hemostasis, Endoscopic ; Humans ; *Upper Gastrointestinal Tract

Adolescent ; Adult ; Aged ; Electrodes ; Epistaxis ; surgery ; Female ; Hemostasis, Endoscopic ; methods ; Humans ; Male ; Middle Aged ; Young Adult

Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.
Enbucrilate/*therapeutic use ; Endoscopy, Gastrointestinal/*methods ; Esophageal and Gastric Varices/*diagnosis/physiopathology/*therapy ; Gastrointestinal Hemorrhage/*diagnosis/physiopathology/*therapy ; Hemostasis, Endoscopic/*methods ; Humans ; Sclerotherapy/methods

OBJECTIVE: To compare the hemostatic efficacy and safety of endoscopic band ligation(EBL) and endoscopic hemoclip placement(EHP) for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract. METHODS: Between February 2004 and October 2006, 34 patients with Dieulafoy lesions in the upper gastrointestinal tract were prospectively enrolled,including 22 cases of lesions in the stomach,10 in gastrointestinal stoma,and 2 in duodenal, who were randomly assigned to undergo EBL (n=16) or EHP (n=18). The therapeutic results of these 2 groups were compared. RESULTS: The median number of O-ring or hemoclip required in the EBL group and the EHP group was similar. The rate of primary haemostasis,recurrent bleeding,transfer into surgery, complications, and average stay and blood transfusion requirements did not significantly differ in the 2 groups (P>0.05). CONCLUSION In this study, no significant differences are detected in the efficacy and the safety of EBL vs. EHP for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract.
Adult ; Aged ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastric Mucosa ; surgery ; Gastrointestinal Hemorrhage ; surgery ; Hemostasis, Endoscopic ; methods ; Humans ; Ligation ; methods ; Male ; Middle Aged ; Prospective Studies ; Surgical Instruments

BACKGROUND/AIMS: Dieulafoy lesions are an important cause of upper gastrointestinal bleeding. The purpose of this study was to assess the efficacy of endoscopic treatment for these lesions and to identify the possible predictive factors for rebleeding associated with clinical and endoscopic characteristics. METHODS: Records from 44 patients admitted with Dieulafoy bleeding between January 2006 and December 2007 were reviewed. We retrospectively analyzed the clinical and endoscopic findings and then correlated the rebleeding risk factors with Dieulafoy lesions. RESULTS: Primary hemostasis was achieved by endoscopic treatment in 39 patients (88.6%). There were no significant differences between the rebleeding and non-rebleeding groups with respect to age, gender, initial hemoglobin levels, presence of shock, concurrent disease, location of bleeding, or initial hemostatic treatment methods. However, the use of non-steroidal anti-inflammatory drugs or anticoagulants (p=0.02) and active stages in the Forrest classification (p<0.01) were risk factors for rebleeding after endoscopic therapy. CONCLUSIONS: Endoscopic therapy is effective and safe for treating Dieulafoy lesions, and it has both short- and long-term benefits. Early identification of risk factors such as the use of non-steroidal anti-inflammatory drugs or anticoagulants and the Forrest classification of bleeding predict the outcome of Dieulafoy lesions.
Adult ; Aged ; Arteriovenous Malformations/complications/*therapy ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Hemostasis, Endoscopic/*methods ; Humans ; Male ; Middle Aged ; Recurrence ; Risk Factors

Peptic ulcer bleeding is treated using endoscopic hemostasis using clips or bands. Pancreas divisum (PD), a congenital anomaly of the pancreas, usually has no clinical symptoms; however, pancreatitis may occur if there are disturbances in the drainage of pancreatic secretions. We report an unusual case of PD accompanied by acute pancreatitis, following endoscopic band ligation for duodenal ulcer bleeding. A 48-year-old woman was admitted to our hospital due to melena. An upper endoscopy revealed a small ulcer with oozing adjacent minor papilla. An endoscopic band ligation was performed on this lesion. Acute pancreatitis developed suddenly 6 hours after the band ligation and improved dramatically after removal of the band. Magnetic resonance cholangiopancreatography was performed, revealing complete PD. Endoscopic band ligation is known as the effective method for peptic ulcer bleeding; however, it should be used carefully in duodenal ulcer bleeding near the minor duodenal papilla due to the possibility of PD.
Cholangiopancreatography, Magnetic Resonance ; Drainage ; Duodenal Ulcer* ; Endoscopy ; Female ; Hemorrhage* ; Hemostasis, Endoscopic* ; Humans ; Ligation ; Melena ; Methods ; Middle Aged ; Pancreas* ; Pancreatic Ducts ; Pancreatitis* ; Peptic Ulcer ; Ulcer