Skip to main content
SpringerLink
Log in

Endoscopic Management of Bleeding

  • Chapter
  • First Online:
The SAGES Manual Operating Through the Endoscope

  • 907 Accesses

Abstract

Though gastrointestinal (GI) hemorrhage is common, it can be a life-threatening condition. There are numerous etiologies for GI bleeding, and these are often grouped according to location in the GI tract. With the increasing use of endoscopy for diagnosis of GI bleeding, the development of endoscopic hemostatic techniques has followed. Injection therapy, electrocautery, and hemostatic clips were some of the early hemostatic modalities available for use. Today, the number of available endoscopic hemostatic devices has grown to include band ligation, sclerotherapy, over-the-scope clips, and full thickness suturing techniques. This chapter examines the etiologies of upper, lower, and obscure GI bleeding, and presents techniques to manage GI hemorrhage through the endoscope.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):209–24.

    Article  PubMed  Google Scholar 

  2. Barkun A, Sabbah S, Fallone C, et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. AM J Gastroenterol. 2004;99:1238–46.

    Article  PubMed  Google Scholar 

  3. Barkun A, Leontiadis G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease. Am J Med [Internet]. 2010;123(4):358–66.e2. Elsevier Inc.

    Article  Google Scholar 

  4. Longstreth G. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92(3):419–24.

    CAS  PubMed  Google Scholar 

  5. Leighton JA, Goldstein J, Hirota W, et al. Obscure gastrointestinal bleeding. Gastrointest Endosc. 2003;58(5):650–5.

    Article  PubMed  Google Scholar 

  6. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clin N Am Internet. 2012;92(6):1403–23. Elsevier Inc.

    Article  Google Scholar 

  7. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. [Internet] 2013(Issue 2):Art. No.: CD000567. doi:10.1002/14651858.CD000567.pub6.

  8. Jairath V, Barkun AN. The overall approach to the management of upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am [Internet]. 2011;21(4):657–70. Elsevier Inc.

    Article  Google Scholar 

  9. Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J. The ASGE National Survey on upper gastrointestinal bleeding. Gastrointest Endosc [Internet]. 1981;27(2):94–102. Elsevier.

    Article  Google Scholar 

  10. Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000;356:1318–21.

    Article  CAS  PubMed  Google Scholar 

  11. Rockall TA, Logan RFA, Devlin HB, Northfield TC, Thames W, Thames SW. Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996;38:316–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Chung SC, Leung JW, Steele RJ, Crofts TJ, Li AK. Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. Br Med J (Clin Res Ed) [Internet]. 1988;296(6637):1631–3.

    Article  CAS  Google Scholar 

  13. Liou T-C, Lin S-C, Wang H-Y, Chang W-H. Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleeding. World J Gastroenterol [Internet]. 2006;12(19):3108–13.

    CAS  Google Scholar 

  14. Bianco MA, Rotondano G, Marmo R, Piscopo R, Orsini L, Cipolletta L. Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial. Gastrointest Endosc [Internet]. 2004;60(6):910–5.

    Article  Google Scholar 

  15. Lo C-C, Hsu P-I, Lo G-H, Lin C-K, Chan H-H, Tsai W-L, et al. Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers. Gastrointest Endosc [Internet]. 2006;63(6):767–73.

    Article  Google Scholar 

  16. Chung SSC, Lau JYW, Sung JJY, Chan ACW, Lai CW, Ng EKW, et al. Randomised comparison between adrenaline injection alone and adrenaline injection plus heat probe treatment for actively bleeding ulcers. Br Med J (Clin Res Ed). 1997;314(May):1307–11.

    Article  CAS  Google Scholar 

  17. Calvet X, Vergara M, Brullet E, Gisbert JP, Campo R. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology. 2004;126(2):441–50.

    Article  PubMed  Google Scholar 

  18. Lau JYW, Sung JJY, Lee KKC, Yung M-Y, Wong SKH, Wu JCY, et al. Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;343(5):310–6.

    Article  CAS  PubMed  Google Scholar 

  19. Cárdenas A, Ginès P. Portal hypertension. Curr Opin Gastroenterol [Internet]. 2009;25(3):195–201.

    Article  Google Scholar 

  20. Sarin S, Guptan R. A randomized controlled trial of endoscopic variceal band ligation for primary prophylaxis of variceal bleeding. Eur J Gastroenterol Hepatol. 1996;8(4):337–42.

    Article  CAS  PubMed  Google Scholar 

  21. Lay C-S, Tsai Y-T, Teg C-Y, Shyu W-S, Guo W-S, Wu K-L, et al. Endoscopic variceal ligation in prophylaxis of first variceal bleeding in cirrhotic patients with high-risk esophageal varices. Hepatology. 1997;25(6):1346–50.

    Article  CAS  PubMed  Google Scholar 

  22. Virk C, Coelho-prabhu N, Buttar NS. Chapter 13—Portal hypertensive bleeding [Internet]. Clinical gastrointestinal endoscopy. 2nd ed. London: Elsevier Inc.; 2012.

    Google Scholar 

  23. Haddock G, Garden OJ, McKee RF, Anderson JR, Carter DC. Esophageal tamponade in the management of acute variceal hemorrhage. Dig Dis Sci. 1989;34:913–8.

    Article  CAS  PubMed  Google Scholar 

  24. Crisan D, Tantau M, Tantau A. Endoscopic management of bleeding gastric varices—an updated overview. Curr Gastroenterol Rep [Internet]. 2014;16(10):413.

    Article  Google Scholar 

  25. Sarin SK, Jain AK, Jain M, Gupta R. A randomized controlled trial of cyanoacrylate versus alcohol injection in patients with isolated fundic varices. Am J Gastroenterol. 2002;97:1010–5.

    Article  CAS  PubMed  Google Scholar 

  26. Lo GH, Lai KH, Cheng JS, Chen MH, Chiang HT. A prospective, randomized trial of butyl cyanoacrylate injection versus band ligation in the management of bleeding gastric varices. Hepatology [Internet]. 2001;33(5):1060–4.

    Article  CAS  Google Scholar 

  27. Sugawa C, Benishek D, Walt AJ. Mallory-Weiss syndrome. A study of 224 patients. Am J Surg [Internet]. 1983;145(1):30–3.

    Article  CAS  Google Scholar 

  28. Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med. 1987;316:1613–7.

    Article  CAS  PubMed  Google Scholar 

  29. Cho Y, Chae H, Kim H. Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding. World J Gastroenterol [Internet]. 2008;14(13):2080–4.

    Article  Google Scholar 

  30. Baettig B, Haecki W, Lammer Jr F. Dieulafoy’s disease: endoscopic treatment and follow up. Gut. 1993;34(4):1418–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Baxter M, Aly EH. Dieulafoy’s lesion: current trends in diagnosis and management. Ann R Coll Surg Engl [Internet]. 2010;92(7):548–54.

    Article  CAS  Google Scholar 

  32. Stark M, Gostout C, Balm R. Clinical features and endoscopic management of Dieulafoy’s disease. Gastrointest Endosc [Internet]. 1992;38(5):545–50.

    Article  CAS  Google Scholar 

  33. Matsui S, Kamisako T, Kudo M, Inoue R. Endoscopic band ligation for control of nonvariceal upper GI hemorrhage: comparison with bipolar electrocoagulation. Gastrointest Endosc [Internet]. 2002;55(2):214–8.

    Article  Google Scholar 

  34. Park C, Joo Y, Kim H, Choi S. A prospective, randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy’s lesions. Endoscopy [Internet]. 2004;36(8):677–81.

    Article  CAS  Google Scholar 

  35. Lewis M. Bleeding colonic diverticula. J Clin Gastroenterol [Internet]. 2008;42(10):1156–8.

    Article  Google Scholar 

  36. Martel J, Raskin JB. History, incidence, and epidemiology of diverticulosis. J Clin Gastroenterol [Internet]. 2008;42(10):1125–7.

    Article  Google Scholar 

  37. Jensen DM, Machicado GA, Jutabha R, Kovacs TOG. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342(2):78–82.

    Article  CAS  PubMed  Google Scholar 

  38. Yen EF, Ladabaum U, Muthusamy VR, Cello JP, McQuaid KR, Shah JN. Colonoscopic treatment of acute diverticular hemorrhage using endoclips. Dig Dis Sci [Internet]. 2008;53(9):2480–5 [cited 2014 Sep 21].

    Article  Google Scholar 

  39. Pardi DS, Loftus EV, Tremaine WJ, Sandborn WJ, Alexander GL, Balm RK, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc [Internet]. 1999;49(2):153–7.

    Article  CAS  Google Scholar 

  40. Anderloni A, Jovani M, Hassan C, Repici A. Advances, problems, and complications of polypectomy. Clin Exp Gastroenterol [Internet]. 2014;7:285–96.

    Google Scholar 

  41. Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc [Internet]. 2000;51(6):690–6.

    Article  CAS  Google Scholar 

  42. Chou K-C, Yen H-H. Combined endoclip and endoloop treatment for delayed postpolypectomy hemorrhage. Gastrointest Endosc [Internet]. 2010;72(1):218–9. Elsevier Inc. [cited 2014 Sep 21].

    Article  Google Scholar 

  43. Shioji K, Suzuki Y, Kobayashi M, Nakamura A, Azumaya M, Takeuchi M, et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2003;57(6):691–4.

    Article  PubMed  Google Scholar 

  44. Paspatis GA, Paraskeva K, Theodoropoulou A, Mathou N, Vardas E, Oustamanolakis P, et al. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol [Internet]. 2006;101(12):2805–9.

    Article  CAS  Google Scholar 

  45. Moser K-H, Mosch C, Walgenbach M, Bussen DG, Kirsch J, Joos AK, et al. Efficacy and safety of sclerotherapy with polidocanol foam in comparison with fluid sclerosant in the treatment of first-grade haemorrhoidal disease: a randomised, controlled, single-blind, multicentre trial. Int J Colorectal Dis [Internet]. 2013;28(10):1439–47.

    Article  Google Scholar 

  46. Macrae HM, Mcleod RS. Comparison of hemorrhoid treatments: a meta-analysis. Surg Pract. 1997;40(1):14–7.

    CAS  Google Scholar 

  47. Rockey DC. Occult and obscure gastrointestinal bleeding: causes and clinical management. Nat Rev Gastroenterol Hepatol [Internet]. 2010;7(5):265–79. Nature Publishing Group.

    Article  Google Scholar 

  48. Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology [Internet]. 2007;133(5):1697–717 [cited 2014 Jul 9].

    Article  Google Scholar 

  49. Eliakim R. Video capsule endoscopy of the small bowel. Curr Opin Gastroenterol [Internet]. 2008;24(2):159–63.

    Article  Google Scholar 

  50. Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53(2):216–20.

    Article  CAS  PubMed  Google Scholar 

  51. Kirschniak A, Kratt T, Stüker D, Braun A, Schurr M-O, Königsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007;66(1):162–7.

    Article  PubMed  Google Scholar 

  52. Pauli EM, Delaney CP, Champagne B, Stein S, Marks JM. Safety and effectiveness of an endoscopic suturing device in a human colonic treat-and-resect model. Surg Innov. 2013;20(6):594–9.

    Article  PubMed  Google Scholar 

  53. Kurian AA, Bhayani NH, Reavis K, Dunst C, Swanström L. Endoscopic suture repair of full-thickness esophagotomy during per-oral esophageal myotomy for achalasia. Surg Endosc. 2013;27(10):3910.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Disease Institute - Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Kathryn E. Fong M.D. & Kevin El-Hayek M.D.

  2. Digestive Disease Institute -Department of General Surgery, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates

    Kevin El-Hayek M.D.

Authors
  1. Kathryn E. Fong M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin El-Hayek M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin El-Hayek M.D. .

Editor information

Editors and Affiliations

  1. Cleveland Clinic, Section of Surgical Endoscopy, Cleveland, Ohio, USA

    Matthew Kroh

  2. The Oregon Clinic, Division of Gastrointestinal Surgery, Portland, Oregon, USA

    Kevin M. Reavis

Rights and permissions

Reprints and permissions

Copyright information

© 2016 SAGES

About this chapter

Cite this chapter

Fong, K.E., El-Hayek, K. (2016). Endoscopic Management of Bleeding. In: Kroh, M., Reavis, K. (eds) The SAGES Manual Operating Through the Endoscope. Springer, Cham. https://doi.org/10.1007/978-3-319-24145-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-24145-6_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-24143-2

  • Online ISBN: 978-3-319-24145-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation