AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review

Recent advances in endoscopic devices and techniques now enable endoscopists to treat NVUGIB lesions more effectively and with a variety of often complementary methods. With this expanded endoscopic armamentarium, endoscopic therapy should achieve hemostasis in the majority of patients with NVUGIB. Hemostatic forceps, over-the-scope clips, and sprayed hemostatic powders are newer and relatively expensive endoscopic devices that have established roles in treating NVUGIB, and may be particularly useful in difficult-to-treat or recurrent bleeding lesions. Despite the increased costs of newer devices or multimodal therapy, effective hemostasis to prevent rebleeding and the need for hospital readmission is likely to be a dominant cost-saving strategy. Practicing endoscopists should be comfortable applying conventional thermal therapy and placing hemoclips, and they should familiarize themselves with newer techniques to manage NVUGIB, which can occur from a variety of etiologies ranging from peptic ulcer disease to adverse events after therapeutic endoscopy. In situations where thermal or mechanical therapies are not successful at achieving hemostasis, sprayed hemostatic powder is a valuable rescue therapy; and it might also enable endoscopists with limited training or backup to temporize severely bleeding lesions to allow time for transfer to a specialized referral center. Finally, multidisciplinary consultation and an assessment of endoscopic, radiographic, and surgical expertise should inform the selection of therapy in refractory NVUGIB.