Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)
Mansour A. Parsi, MD, MPH, FASGE,
Allison R. Schulman, MD, MPH,
Harry R. Aslanian, MD, FASGE,
Manoop S. Bhutani, MD, FASGE,
Kuman Krishnan, MD,
David R. Lichtenstein, MD, FASGE,
Joshua Melson, MD, FASGE,
Udayakumar Navaneethan, MD,
Rahul Pannala, MD, MPH, FASGE,
Amrita Sethi, MD, FASGE,
Guru Trikudanathan, MD,
Arvind J. Trindade, MD,
Rabindra R. Watson, MD,
John T. Maple, DO, FASGE
Affiliations
Mansour A. Parsi, MD, MPH, FASGE
Section for Gastroenterology & Hepatology, Tulane University Health Sciences Center, New Orleans, LA
Allison R. Schulman, MD, MPH
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
Harry R. Aslanian, MD, FASGE
Section of Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, CT
Manoop S. Bhutani, MD, FASGE
Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, TX
Kuman Krishnan, MD
Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA
David R. Lichtenstein, MD, FASGE
Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA
Joshua Melson, MD, FASGE
Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
Udayakumar Navaneethan, MD
Center for Interventional Endoscopy, Florida Hospital, Orlando, FL
Rahul Pannala, MD, MPH, FASGE
Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ
Amrita Sethi, MD, FASGE
Division of Digestive and Liver Diseases, New York-Presbyterian/Columbia University Medical Center, New York, NY
Guru Trikudanathan, MD
Division of Gastroenterology, University of Minnesota, Minneapolis, MN
Arvind J. Trindade, MD
Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY
Rabindra R. Watson, MD
Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA
John T. Maple, DO, FASGE
Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Reprint requests: John T. Maple, DO, FASGE, ASGE Technology Committee Chair, 800 Stanton L Young Blvd, AAT 7400, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
Background: Endoscopic intervention is often the first line of therapy for GI nonvariceal bleeding. Although some of the devices and techniques used for this purpose have been well studied, others are relatively new, with few available outcomes data. Methods: In this document, we review devices and techniques for endoscopic treatment of nonvariceal GI bleeding, the evidence regarding their efficacy and safety, and financial considerations for their use. Results: Devices used for endoscopic hemostasis in the GI tract can be classified into injection devices (needles), thermal devices (multipolar/bipolar probes, hemostatic forceps, heater probe, argon plasma coagulation, radiofrequency ablation, and cryotherapy), mechanical devices (clips, suturing devices, banding devices, stents), and topical devices (hemostatic sprays). Conclusions: Endoscopic evaluation and treatment remains a cornerstone in the management of nonvariceal upper- and lower-GI bleeding. A variety of devices is available for hemostasis of bleeding lesions in the GI tract. Other than injection therapy, which should not be used as monotherapy, there are few compelling data that strongly favor any one device over another. For endoscopists, the choice of a hemostatic device should depend on the type and location of the bleeding lesion, the availability of equipment and expertise, and the cost of the device.
