Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding

Table 1 Risk factors for non-variceal upper gastrointestinal bleeding

Risk factors	Value of parameter
History of peptic ulcer
Helicobacter pylori infection
Use of anticoagulant and antiplatelet drugs
Prolonged INR	INR ≥ 1.21
Increase in leukocyte count
Hypoalbuminemia	Serum albumin level < 35 g/L

INR: International normalized ratio.

Table 2 List of risk assessment scores for non-variceal upper gastrointestinal bleeding

Type of risk assessment score	Examples
Pre-endoscopy risk score	ABC score
	AIMS65 score
	CANUKA score
	Glasgow-Blatchford Score
	INBS
	MAP (ASH) score
	Pre-endoscopic Rockall score
Post-endoscopy risk score	Complete Rockall score
	CSMCPI score
	PNED score

ABC: Age, blood tests, co-morbidities; AIMS65: Albumin, International normalized ratio, Mental status, Systolic blood pressure, Age ≥ 65 years; CANUKA: Canada–United Kingdom-Adelaide; INBS: International bleeding score; MAP (ASH): Mental status, American Society of Anesthesiology classification, Pulse, Albumin, Systolic blood pressure, Hemoglobin; CSMCPI: Cedars Sinai Medical Centre Predictive Index; PNED: Progretto nazional emoragia digestive.

Table 3 Summary of emerging endoscopic modalities for the management of non-variceal upper gastrointestinal bleeding

Modality type	Endoscopic modalities	Mechanism of action
Injection	Endoscopic ultrasound-guided angiotherapy	Controls variceal bleeding by deploying coils and injecting cyanoacrylate glue directly into targeted vessels, and confirming the thrombosis in real time with Doppler
Thermal	Coagulation grasper (Coagrasper)	A combination mechanical and thermal hemostasis device that delivers targeted monopolar coagulation at the precise site of bleeding
	Radiofrequency ablation	High-frequency alternating electrical current delivered to local tissue via radiofrequency electrode, causing thermal coagulative necrosis of the targeted tissue
	Cryotherapy	Induces cell necrosis through cycles of controlled local freezing and thawing of the tissue
	Endoscopic laser coagulation	Instantaneous hemostatic effect due to alterations in structural proteins in the vessel wall causing vessel shrinkage
Topical	Hemospray (TC-325 hemostatic powder)	Non-absorbable mineral powder that forms an adhesive mechanical barrier upon contact with water
	EndoClot (polysaccharide hemostatic powder)	Absorbable modified plant-based polymer that forms a protective gel matrix and concentrates coagulation factors upon contact with water
	Oxidized regenerated cellulose	Absorbable plant-based polymer that provides a matrix for clot formation and enhances platelet activation and adhesion
	Ankaferd Blood Stopper	Standardized mixture of plant extracts that induces formation of an encapsulated protein network which provides focal points for vital erythrocyte aggregation
Mechanical	Over-the-scope clip system	Large caliber clips made of metal alloy nitinol with shape-memory effect that stops bleeding by exerting constant circumferential compression force on the bleeding site
	Endoscopic suturing device	Excludes peptic ulcer from the intra-gastric acidic environment to prevent rebleeding
	Endoscopic band ligation	Complete obliteration of varices by causing mechanical strangulation with rubber bands