Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review

Abstract

Upper gastrointestinal (GI) hemorrhage presents a substantial clinical challenge. Initial management typically involves resuscitation and endoscopy within 24 h, although the benefit of very early endoscopy (< 12 h) for high-risk patients is debated. Treatment goals include stopping acute bleeding, preventing rebleeding, and using a multimodal approach encompassing endoscopic, pharmacological, angiographic, and surgical methods. Pharmacological agents such as vasopressin, prostaglandins, and proton pump inhibitors are effective, but the increase in antithrombotic use has increased GI bleeding morbidity. Endoscopic hemostasis, particularly for nonvariceal bleeding, employs techniques such as electrocoagulation and heater probes, with concerns over tissue injury from monopolar electrocoagulation. Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations. Currently, the first-line therapy includes thermal probes and hemoclips, with over-the-scope clips emerging for larger ulcer bleeding. The gold probe, combining bipolar electrocoagulation and injection, offers targeted coagulation but has faced device-related issues. Future advancements involve combining techniques and improving endoscopic imaging, with studies exploring combined approaches showing promise. Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.

Keywords: Upper gastrointestinal bleeding, Hemostasis, Endoscopy, Probe, Spray, Clip

Core Tip: Endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding primarily involves electrocoagulation and heater probes, though monopolar electrocoagulation raises tissue injury concerns. Newer methods such as Hemospray and Endoclot offer mechanical tamponade but with limitations. First-line treatments currently include thermal probes and hemoclips, with over-the-scope clips gaining traction for larger ulcers. The gold probe, merging bipolar electrocoagulation and injection, targets coagulation effectively but has device-related issues. Future progress lies in integrating techniques and enhancing endoscopic imaging. Research is vital to establish standardized, effective hemorrhage management strategies.