Thermal probe or combination therapy for nonvariceal upper gastrointestinal hemorrhage

Abstract

Nonvariceal upper gastrointestinal (UGI) hemorrhage is a common reason for emergency care and hospitalization. Ulcer bleeding accounts for about 50% of the cases, and less common causes are angiomas, Mallory-Weiss tears, Dieulafoy's lesion, and UGI cancers. My specific purposes are: (1) to consider the details of care before emergency endoscopy and the timing of therapeutic endoscopy, (2) to describe the techniques that the Center for Ulcer Research and Education (CURE) Hemostasis Research Group uses for endoscopic hemostasis of different stigmata of ulcer hemorrhage, and (3) to detail the techniques for treatment of bleeding Mallory-Weiss tears and Dieulafoy's lesions. The emphasis is more on the methods than the results of endoscopic hemostasis. There has been significant progress and changes in the care of patients with nonvariceal UGI hemorrhage in the last 2 decades and these developments will be discussed. Examples of changes that have become the standard of care are the following: using stigmata of ulcer hemorrhage for prognostication, choosing different techniques for endoscopic hemostasis of different stigmata of ulcer hemorrhage, and use of algorithms for endoscopic treatment of bleeding Mallory-Weiss tears and Dieulafoy's lesions. Standardized approaches to the diagnosis and treatment are now recommended because they have been show to significantly improve the condition of patients with severe nonvariceal hemorrhage.