What Does Lesion Blood Flow Tell Us About Risk Stratification and Successful Management of Non-variceal UGI Bleeding?

Abstract

Purpose of review: There has been a decline in mortality associated with upper gastrointestinal (UGI) hemorrhage as the use of urgent endoscopy has increased. This review will examine endoscopic risk stratification of non-variceal UGI bleeding (e.g., ulcers, Dieulafoy lesions, and Mallory-Weiss tears), including the use of the Doppler endoscopic probe (DEP).

Recent findings: Prospective studies evaluating the use of DEP in non-variceal UGI hemorrhage showed that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared to those with intermediate-risk SRH. Additionally, lesions with a persistently positive DEP signal after endoscopic hemostasis were seen with high-risk SRH and had a higher 30-day rebleeding rate. Residual arterial blood flow underneath ulcers is a significant risk factor for rebleeding. However, if more endoscopic treatment is applied, clinical outcomes for patients with severe non-variceal UGI hemorrhage are improved, as documented by a recent CURE Hemostasis randomized controlled trial (RCT).

Keywords: Doppler endoscopic probe; Risk stratification; Upper gastrointestinal bleeding.

Fig. 1

a A picture of the VTI Doppler endoscopic control unit and an endoscopic catheter. b A diagram of an ulcer base with an invisible artery underneath that can be located by the Doppler endoscopic probe as it courses in the ulcer base. The ear indicates that an auditory sound results as a “swish, swish” for the artery

Fig. 2

Once the artery is localized under and out from the stigmata such as non-bleeding visible vessel, hemoclips can be accurately placed on either side of the stigma to obliterate the underlying arterial blood flow