New and old methods for endoscopic control of nonvariceal upper gastrointestinal bleeding.

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Candidates for endoscopic therapy of nonvariceal upper gastrointestinal bleeding include patients with bleeding ulcers, Mallory-Weiss tears, angiodysplasia, and Dieulafoy or other lesions with active bleeding, non-bleeding visible vessel, or adherent clot. Continuous infusion of intravenous proton pump inhibitors lowers rebleeding risk after endoscopic therapy. Of standard methods, a combination of epinephrine injection with thermal coagulation (bipolar or heater probe) has been shown to be optimal, with lower rebleeding rates (5-10%) than for either method alone. Endoscopic clipping is an appealing technique, but comparative data with other methods are limited and conflicting. Band ligation is also suitable for many non-ulcer lesions without a firm base. Argon plasma coagulation is most useful for lesions with a large surface area such as watermelon stomach, but of uncertain advantage for other nonvariceal bleeding lesions. Regardless of method used, technical expertise plays a role in the outcomes of therapy. Of future interest are techniques to image beneath the surface and predict rebleeding risk, and improved methods of mechanical hemostasis.

Original languageEnglish (US)
Pages (from-to)62-65
Number of pages4
JournalRevista de gastroenterología de México
Volume68 Suppl 3
StatePublished - Nov 2003


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