Efficacy of Endoscopic Hemostasis with Soft Coagulation Using Hemostatic Forceps for Upper Gastrointestinal Bleeding over a 12-year Period: 2016 ACG Presidential Poster Award

Abstract

Introduction: The endoscopic submucosal dissection (ESD) technique was introduced to obtain en bloc specimens of early gastric cancer. Endoscopic high-frequency soft coagulation is used to manage visible bleeding and/or nonbleeding vessels during ESD. Upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency, and has a considerable morbidity and mortality. This study aimed to compare the etiology and clinical outcome of nonvariceal UGIB between two periods during the last 12 years. Methods: The present retrospectively study evaluated the medical records of patients who underwent emergency endoscopic hemostasis for nonvariceal UGIB from 2003 to 2014. The patients were divided into two periods: the first period was from 2003 to 2008 and the second period was from 2009 to 2014. The study revealed the characteristics of these patients and compared the treatment outcome of endoscopic hemostasis between soft coagulation and other modalities. In addition, endoscopic hemostasis rate was compared between specialists and trainees. The specialists already had the fundamental skills and knowledge needed for ESD, and each specialist assisted more than 40 gastric ESD procedures. Results: 566 patients underwent emergency endoscopy with nonvariceal UGIB. Among the 502 out of 566 patients who underwent endoscopic hemostasis, 197 were in the first period and 305 patients were in the second period. Whereas peptic ulcer lesions were the main cause of bleeding (89.4%) during the whole study period, small and multiple ulcers in addition to duodenal ulcers significantly increased in the second period. Endoscopic hemostasis was successfully performed in 97.0% in the first period and in 95.4% in the second period with no significant difference between the periods. In the modality of hemostasis, the rate of endoscopic hemostasis with soft coagulation using the ESD technique significantly increased in the second period compared to the first period (71.1% vs.11.7%, p < 0.001). The rate of endoscopic hemostasis performed by trainees was significantly higher in the second period than in the first period (76.1% vs.56.3%, p < 0.001). Rebleeding after endoscopic hemostasis decreased in the second period (9.8%) compared to the first period (15.7%). Conclusion: This retrospective study suggested that endoscopic hemostasis with soft coagulation using the ESD technique was safe even performed by trainees and might lead to a lower rebleeding rate after endoscopic hemostasis for UGIB.