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World J Gastrointest Endosc. Jan 16, 2020; 12(1): 1-16
Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.1
Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding: A review
Maliha Naseer, Karissa Lambert, Ahmed Hamed, Eslam Ali
Maliha Naseer, Eslam Ali, Division of Gastroenterology and Hepatology, Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
Karissa Lambert, Ahmed Hamed, Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Maliha Naseer, MD, Gastroenterology Fellow, Division of Gastroenterology and Hepatology, Department of Internal Medicine, East Carolina University, 521 Moye Blvd, Greenville, NC 27834, United States. naseerm18@ecu.edu
Received: March 30, 2019
Peer-review started: April 4, 2019
First decision: August 2, 2019
Revised: August 28, 2019
Accepted: October 19, 2019
Article in press: October 19, 2019
Published online: January 16, 2020
Processing time: 262 Days and 5.1 Hours
Abstract

Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and non-variceal gastrointestinal bleeding. Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally. It is associated with high mortality, morbidity, and cost of the health care system. Despite the continuous improvement of therapeutic endoscopy, the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue. Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection, argon plasma coagulation, heater probe, and placement of through the scope clip, which can be used alone or in combination to decrease the risk of rebleeding. Recently, more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis. This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip, Coagrasper, hemostatic sprays, radiofrequency ablation, cryotherapy, endoscopic suturing devices, and endoscopic ultrasound-guided angiotherapy. In this review article, we will also discuss the technical aspects of the common procedures, outcomes in terms of safety and efficacy, and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.

Keywords: Non-variceal upper gastrointestinal bleeding; Over the scope clip; Hemospray; Radiofrequency ablation; Endoscopic suturing device

Core tip: In the last two decades, there has been drastic decline in the mortality and morbidity caused non-variceal upper gastrointestinal bleeding due to significant progress in the therapeutic endoscopy. The use of devices such as over the scope clips system, Coagrasper, hemospray and endoscopic suturing has tremendously evolved and expanded to achieve hemostasis as a primary method or when conventional therapeutic devices such as heater probe, hemoclips or epinephrine injection fails to control bleeding.