Efficacy of Endoscopic Ultrasound–Guided Hemostatic Interventions for Resistant Nonvariceal Bleeding

A subset of patients with nonvariceal gastrointestinal bleeding fail, or are unsuitable candidates for, endoscopic, radiologic, and surgical interventions. Endoscopic ultrasound (EUS)-guided intervention might be effective in these patients. We performed EUS-guided hemostatic interventions for 17 patients with nonvariceal gastrointestinal bleeding from June 2003 through May 2014 who failed, or were unsuitable candidates for, additional therapies. Indications for treatment included gastrointestinal stromal tumors, colorectal vascular malformations, duodenal masses or polyps, Dieulafoy lesions, duodenal ulcers, rectally invasive prostate cancer, pancreatic pseudoaneurysms, ulcerated esophageal cancer, and ulceration after Roux-en-Y gastric bypass. After the procedure, 88% of patients have had no further bleeding related to the treated lesion, over a median follow-up period of 12 months. EUS-guided hemostatic therapy therefore is feasible and useful for select patients with clinically severe, refractory, or recurrent nonvariceal gastrointestinal bleeding.