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. 2019 Jun 27;4(7):285-299.
doi: 10.1016/j.vgie.2019.02.004. eCollection 2019 Jul.

Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)

ASGE technology committee; Mansour A Parsi  1 , Allison R Schulman  2 , Harry R Aslanian  3 , Manoop S Bhutani  4 , Kuman Krishnan  5 , David R Lichtenstein  6 , Joshua Melson  7 , Udayakumar Navaneethan  8 , Rahul Pannala  9 , Amrita Sethi  10 , Guru Trikudanathan  11 , Arvind J Trindade  12 , Rabindra R Watson  13 , John T Maple  14 ; ASGE Technology Committee Chair
Affiliations

Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)

ASGE technology committee et al. VideoGIE. .

Abstract

Background: Endoscopic intervention is often the first line of therapy for GI nonvariceal bleeding. Although some of the devices and techniques used for this purpose have been well studied, others are relatively new, with few available outcomes data.

Methods: In this document, we review devices and techniques for endoscopic treatment of nonvariceal GI bleeding, the evidence regarding their efficacy and safety, and financial considerations for their use.

Results: Devices used for endoscopic hemostasis in the GI tract can be classified into injection devices (needles), thermal devices (multipolar/bipolar probes, hemostatic forceps, heater probe, argon plasma coagulation, radiofrequency ablation, and cryotherapy), mechanical devices (clips, suturing devices, banding devices, stents), and topical devices (hemostatic sprays).

Conclusions: Endoscopic evaluation and treatment remains a cornerstone in the management of nonvariceal upper- and lower-GI bleeding. A variety of devices is available for hemostasis of bleeding lesions in the GI tract. Other than injection therapy, which should not be used as monotherapy, there are few compelling data that strongly favor any one device over another. For endoscopists, the choice of a hemostatic device should depend on the type and location of the bleeding lesion, the availability of equipment and expertise, and the cost of the device.

Keywords: ABS, Ankaferd blood stopper; APC, argon plasma coagulation; ASGE, American Society for Gastrointestinal Endoscopy; CPT, Current Procedural Terminology; CSEMS, covered self-expandable metallic stent; EBL, endoscopic band ligation; EDP, endoscopic Doppler probe; GAVE, gastric antral vascular ectasia; HP, heater probe; LGIB, lower GI bleeding; MPEC, multipolar electrocoagulation; OTSC, over-the-scope clip; PTFE, polytetrafluoroethylene; RCT, randomized controlled trial; TTS, through-the-scope; U.S. FDA, United States Food and Drug Administration; UGIB, upper GI bleeding.

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Figures

Figure 1
Figure 1
Colonic (left) and gastric (right) Coagrasper hemostatic forceps. (Image used with permission from Gastrointest Endosc 2015;81:1311-25.)
Figure 2
Figure 2
Over-the-scope (left) and Padlock (right) clips in deployed configuration. (Image used with permission form Gastrointest Endosc 2017;85:1087-92.)
See this image and copyright information in PMC

References

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