Endoscopic Ultrasound-Guided Treatments for Non-Variceal Upper GI Bleeding: A Review of the Literature.

Claudio Giovanni De Angelis,Ludovica Venezia,Marcantonio Gesualdo,Felice Rizzi,Giorgio Maria Saracco,Rinaldo Pellicano,Pablo Cortegoso Valdivia,Stefano Rizza

doi:10.3390/jcm9030866

Abstract

Endoscopic injection of glues, clotting factors, or sclerosing agents is a well-known therapy for the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB), but less is known about endoscopic ultrasound (EUS)-guided treatments. In this setting, literature data are scarce, and no randomized controlled trials are available. We performed a review of the existing literature in order to evaluate the role of EUS-guided therapies in the management of NVUGIB. The most common treated lesions were Dieulafoy’s lesions, pancreatic pseudoaneurysms, and gastrointestinal stromal tumors (GISTs). Mostly, the treatments were performed as a salvage option after failure of conventional endoscopic hemostatic attempts, showing good efficacy and a good safety profile, also documented by Doppler monitoring of treated lesions. EUS-guided therapies may be an effective option in the treatment of refractory NVUGIB, thus avoiding radiological or surgical management. Nevertheless, available literature still lacks robust data.

Highlights

Non-variceal upper gastrointestinal bleeding (NVUGIB) is the most common type of acute upper gastrointestinal (GI) bleeding, accounting for 50–160 patients per 100,000 per year [1]
The papers including a total of 41 patients were collected; out of these, 35 patients were treated with the endoscopic ultrasound (EUS)-guided therapy for NVUGIB (20 males and 12 females; in 3 cases, gender was not specified) and were eventually included (Table 1); 6 patients were excluded because EUS-guided treatments were performed on either variceal or colorectal lesions (2 and 4 cases, respectively)
EUS offers an unmatched access to abdominal vessels that until now have only been accessible to surgeons and/or interventional radiologists, and it provides a potential alternative approach to patients with refractory GI bleeding who failed treatment with standard hemostatic techniques

Summary

Introduction

Non-variceal upper gastrointestinal bleeding (NVUGIB) is the most common type of acute upper gastrointestinal (GI) bleeding, accounting for 50–160 patients per 100,000 per year [1]. The mortality rate caused by NVUGIB remains high despite medical and technical improvements, probably due to longer life expectancy of the population [2], even though a decrease has been recorded in nationwide databases in the last 20 years [3]. Despite the evolution of endoscopic hemostatic techniques and tools, some patients are refractory to the standard therapy and need different approaches, such as the surgical or radiological ones. In this setting, endoscopic ultrasound (EUS)-guided techniques could offer, at least theoretically, a feasible option in the treatment of patients with NVUGIB who are refractory to or not eligible for standard therapies

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