Endoscopic Treatment of Upper Gastrointestinal Ulcer Bleeding

Abstract

Peptic ulcer disease is the most common cause of upper gastrointestinal (GI) bleeding. In most of the cases, bleeding from a peptic ulcer stops spontaneously. Arterial diameters in bleeding ulcers can measure up to 3.45 mm, but in most cases the diameter of the bleeding artery is small (< 2 mm). High-dose intravenous proton pump inhibitors after endoscopic therapy for a bleeding ulcer reduce recurrent bleeding risk and surgery. The endoscopic appearance of an ulcer provides important prognostic information. Clean based ulcers and ulcers with a flat pigmented spot have low rebleeding risks. Major stigmata of hemorrhage (an adherent clot, a visible vessel, or active bleeding) are associated with high rebleeding risks. Endoscopic treatment in patients with high-risk stigmata results in improved outcomes. Common endoscopic techniques and the devices used to treat upper GI ulcer bleeding, including injection therapy, thermal coagulation, endoclip application, and hemostatic powder spray are described in the given video. Different clinical scenarios are presented. This article is part of an expert video encyclopedia.