Upper gastrointestinal bleeding endoscopic intervention: Difference between revisions

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==Overview==
==Overview==
In UGIB, it is recommended to perform diagnostic and therapeutic [[endoscopy]] simultaneously. The common procedures used to manage upper GI bleeding caused by the [[peptic ulcer disease]] and [[Esophageal varices|esophageal varice]]<nowiki/>s are [[sclerotherapy]] (EIS), [[coagulation]] ([[Thermal ablation|thermal]], electric, and argon plasma), [[Hemostatic clamp|hemostatic clips]] and variceal band [[ligation]].
==Endoscopic intervention==
==Endoscopic intervention==
In UGIB, diagnostic and therapeutic endoscopy may be performed simultaneously. Therapeutic upper gastrointestinal endoscopy should be performed in all patients with suspected UGIB to evaluate and possibly treat the source of bleeding. The urgency of endoscopy depends on the anticipated source of bleeding, rapidity of blood loss, and hemodynamic stability of the patient. Endoscopic intervention should be undertaken within 24 hours, as early intervention is associated with reduced transfusion needs and a decreased length of stay in high-risk patients with nonvariceal bleeding.<ref name="pmid27744662">{{cite journal |vauthors=Garber A, Jang S |title=Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding |journal=Clin Endosc |volume=49 |issue=5 |pages=421–424 |year=2016 |pmid=27744662 |pmc=5066413 |doi=10.5946/ce.2016.110 |url=}}</ref>
In UGIB, it is recommended to perform both diagnostic and therapeutic [[endoscopy]] simultaneously. [[Endoscopic]] intervention undertaken within 24 hours is not only associated with less [[Blood transfusion|transfusion]] needs but also reduced the length of stay in hospital.<ref name="pmid27744662">{{cite journal |vauthors=Garber A, Jang S |title=Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding |journal=Clin Endosc |volume=49 |issue=5 |pages=421–424 |year=2016 |pmid=27744662 |pmc=5066413 |doi=10.5946/ce.2016.110 |url=}}</ref>
* The American Society of Gastrointestinal Endoscopy guidelines recommend the use of two different endoscopic procedures, rather than a single procedure to better control bleeding and decrease the incidence of re-bleeding.<ref name="HwangShergill2014">{{cite journal|last1=Hwang|first1=Joo Ha|last2=Shergill|first2=Amandeep K.|last3=Acosta|first3=Ruben D.|last4=Chandrasekhara|first4=Vinay|last5=Chathadi|first5=Krishnavel V.|last6=Decker|first6=G. Anton|last7=Early|first7=Dayna S.|last8=Evans|first8=John A.|last9=Fanelli|first9=Robert D.|last10=Fisher|first10=Deborah A.|last11=Foley|first11=Kimberly Q.|last12=Fonkalsrud|first12=Lisa|last13=Jue|first13=Terry|last14=Khashab|first14=Mouen A.|last15=Lightdale|first15=Jenifer R.|last16=Muthusamy|first16=V. Raman|last17=Pasha|first17=Shabana F.|last18=Saltzman|first18=John R.|last19=Sharaf|first19=Ravi|last20=Cash|first20=Brooks D.|title=The role of endoscopy in the management of variceal hemorrhage|journal=Gastrointestinal Endoscopy|volume=80|issue=2|year=2014|pages=221–227|issn=00165107|doi=10.1016/j.gie.2013.07.023}}</ref>
* The American Society of Gastrointestinal Endoscopy guidelines recommend the use of two different [[Endoscopic surgery|endoscopic]] procedures, rather than a single procedure to better control [[bleeding]] and decrease the incidence of re-bleeding.<ref name="HwangShergill2014">{{cite journal|last1=Hwang|first1=Joo Ha|last2=Shergill|first2=Amandeep K.|last3=Acosta|first3=Ruben D.|last4=Chandrasekhara|first4=Vinay|last5=Chathadi|first5=Krishnavel V.|last6=Decker|first6=G. Anton|last7=Early|first7=Dayna S.|last8=Evans|first8=John A.|last9=Fanelli|first9=Robert D.|last10=Fisher|first10=Deborah A.|last11=Foley|first11=Kimberly Q.|last12=Fonkalsrud|first12=Lisa|last13=Jue|first13=Terry|last14=Khashab|first14=Mouen A.|last15=Lightdale|first15=Jenifer R.|last16=Muthusamy|first16=V. Raman|last17=Pasha|first17=Shabana F.|last18=Saltzman|first18=John R.|last19=Sharaf|first19=Ravi|last20=Cash|first20=Brooks D.|title=The role of endoscopy in the management of variceal hemorrhage|journal=Gastrointestinal Endoscopy|volume=80|issue=2|year=2014|pages=221–227|issn=00165107|doi=10.1016/j.gie.2013.07.023}}</ref>
==Management of upper GI bleeding caused by the peptic ulcer disease==
==Management of upper GI bleeding caused by the peptic ulcer disease==
The most common procedures used to manage upper GI bleeding caused by the peptic ulcer disease are:<ref name="pmid26142038">{{cite journal |vauthors=Fujii-Lau LL, Wong Kee Song LM, Levy MJ |title=New Technologies and Approaches to Endoscopic Control of Gastrointestinal Bleeding |journal=Gastrointest. Endosc. Clin. N. Am. |volume=25 |issue=3 |pages=553–67 |year=2015 |pmid=26142038 |doi=10.1016/j.giec.2015.02.005 |url=}}</ref><ref name="pmid18986845">{{cite journal |vauthors=Laine L, McQuaid KR |title=Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=1 |pages=33–47; quiz 1–2 |year=2009 |pmid=18986845 |doi=10.1016/j.cgh.2008.08.016 |url=}}</ref><ref name="pmid15605000">{{cite journal |vauthors=Park CH, Lee SJ, Park JH, Park JH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ |title=Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding |journal=Gastrointest. Endosc. |volume=60 |issue=6 |pages=875–80 |year=2004 |pmid=15605000 |doi= |url=}}</ref>   
The most common procedures used to manage upper GI bleeding caused by the [[peptic ulcer disease]] are:<ref name="pmid26142038">{{cite journal |vauthors=Fujii-Lau LL, Wong Kee Song LM, Levy MJ |title=New Technologies and Approaches to Endoscopic Control of Gastrointestinal Bleeding |journal=Gastrointest. Endosc. Clin. N. Am. |volume=25 |issue=3 |pages=553–67 |year=2015 |pmid=26142038 |doi=10.1016/j.giec.2015.02.005 |url=}}</ref><ref name="pmid18986845">{{cite journal |vauthors=Laine L, McQuaid KR |title=Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=1 |pages=33–47; quiz 1–2 |year=2009 |pmid=18986845 |doi=10.1016/j.cgh.2008.08.016 |url=}}</ref><ref name="pmid15605000">{{cite journal |vauthors=Park CH, Lee SJ, Park JH, Park JH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ |title=Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding |journal=Gastrointest. Endosc. |volume=60 |issue=6 |pages=875–80 |year=2004 |pmid=15605000 |doi= |url=}}</ref>   
*'''Sclerotherapy (EIS)'''
*'''Sclerotherapy (EIS)'''
*'''Coagulation''' (thermal, electric, and argon plasma)
*'''Coagulation''' (thermal, electric, and argon plasma)
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=== Endoscopic '''Coagulation''' ===
=== Endoscopic '''Coagulation''' ===
* Thermal contact probes are the mainstay of endoscopic hemostasis in upper GI bleeding.  
* Thermal contact probes are the mainstay of endoscopic hemostasis in upper GI bleeding.<ref name="pmid26421105">{{cite journal |vauthors=Szura M, Pasternak A |title=Upper non-variceal gastrointestinal bleeding - review the effectiveness of endoscopic hemostasis methods |journal=World J Gastrointest Endosc |volume=7 |issue=13 |pages=1088–95 |year=2015 |pmid=26421105 |pmc=4580950 |doi=10.4253/wjge.v7.i13.1088 |url=}}</ref>
** '''Contact types''' :Heater probe, monopolar and bipolar electrocoagulation
** '''Contact types''' :Heater probe, monopolar and bipolar electrocoagulation
** '''Noncontact types''' :Laser treatment, argon plasma coagulation 
** '''Noncontact types''' :Laser treatment, argon plasma coagulation 


==== Contact probes ====
==== Contact probes ====
* Contact probes physically tamponade a blood vessel to stop bleeding and interrupt underlying blood flow.
* The most commonly employed contact probe in the management of upper GI bleeding is a [[Electrocoagulation|multipolar electrocoagulation]] probe.
* Thermal energy is then applied to seal the underlying vessel (coaptive coagulation).
* With contact probes blood flow is stopped by clamping followed by induction of [[Thermal energy|heat]]  for the occlusion of the bleeding vessel.
* The most commonly used probe is a multipolar electrocoagulation (MPEC) probe, also referred to as a ''bipolar electrocoagulation probe '', with which heat is created by current flowing between intertwined electrodes on the tip of the probe.
* The most feared complication of thermal probes is [[perforation]] of arteries and surrounding tissue.  
* Heater probes provide a predetermined amount of joules of energy, which does not vary with tissue resistance and can effectively coagulate arteries up to 2 mm in diameter, a diameter considerably larger than most secondary or tertiary branches of arteries (usually 1 mm) found in resected bleeding human peptic ulcers.
* The main risk of using a thermal probe is perforation with excessive application of coagulation or pressure, especially in acute or nonfibrotic lesions.
* Thermal probes can also cause a coagulation injury that can make lesions larger and deeper and may induce delayed bleeding in patients with a coagulopathy.  


==== '''Noncontact types''' ====
==== '''Noncontact types''' ====
* Noncontact thermal therapy includes argon plasma coagulation and laser;
* Noncontact types rarely used now in endoscopic management.
* Noncontact types rarely used now in endoscopic management.
* Noncontact thermal therapy includes [[argon plasma coagulation]] and [[laser]].


=== Endoscopic '''Hemostatic clips''' ===
=== Endoscopic '''Hemostatic clips''' ===
* Hemostatic clips apply mechanical pressure to a bleeding site and control bleeding.<ref name="pmid26894683">{{cite journal |vauthors=Albert JG, Peiffer KH |title=[New methods for endoscopic hemostasis: focus on non-variceal gastrointestinal bleeding] |language=German |journal=Z Gastroenterol |volume=54 |issue=3 |pages=250–5 |year=2016 |pmid=26894683 |doi=10.1055/s-0035-1566987 |url=}}</ref>
* Endoscopic hemoclips differ from surgical clips in that they do not have as much compressive strength
* The first-generation hemoclips could not stop bleeding in vessels larger than a diameter of 1 mm,  but subsequent hemoclips have been larger and stronger and have had a grasp and release mechanism that improves endoscopic deployment and hemostasis.
* [[Hemostatic clamp|Hemostatic clips]] apply mechanical pressure using  a [[Surgery|surgical]] scissors with a locking clamp to control the bleeding.<ref name="pmid26894683">{{cite journal |vauthors=Albert JG, Peiffer KH |title=[New methods for endoscopic hemostasis: focus on non-variceal gastrointestinal bleeding] |language=German |journal=Z Gastroenterol |volume=54 |issue=3 |pages=250–5 |year=2016 |pmid=26894683 |doi=10.1055/s-0035-1566987 |url=}}</ref>
* Hemoclips are useful for patients with malnutrition or coagulopathy  but can also be difficult to deploy depending on the location of the bleeding site, the degree of fibrosis of the underlying lesion, and limitations to endoscopic access.
* Hemoclips are useful for patients with [[malnutrition]] or [[coagulopathy]].
* Endoscopic hemoclips differ from surgical clips in that they do not have as much compressive strength, and the currently available clips do not close completely but leave a small space between the prongs.
* Hemoclips cannot be used in situations where bleeding site is deeper or unable to access using endoscopic procedure.
{{#ev:youtube|59uO-8UVC2A}}
{{#ev:youtube|59uO-8UVC2A}}


==Management of upper GI bleeding caused by the esophageal varices==
==Management of upper GI bleeding caused by the esophageal varices==
The most common procedures used to manage esophageal varices are:<ref name="pmid1530782">{{cite journal |vauthors=Cook DJ, Guyatt GH, Salena BJ, Laine LA |title=Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis |journal=Gastroenterology |volume=102 |issue=1 |pages=139–48 |year=1992 |pmid=1530782 |doi= |url=}}</ref>
The most common procedures used to manage [[esophageal varices]] are:<ref name="pmid1530782">{{cite journal |vauthors=Cook DJ, Guyatt GH, Salena BJ, Laine LA |title=Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis |journal=Gastroenterology |volume=102 |issue=1 |pages=139–48 |year=1992 |pmid=1530782 |doi= |url=}}</ref>
*'''Sclerotherapy'''  
*'''Sclerotherapy'''  
*'''Variceal band ligation'''
*'''Variceal band ligation'''
===Endoscopic band ligation (EBL)===
===Endoscopic band ligation (EBL)===
*EBL involves the placement of elastic circular ring ligatures around the varices to cause strangulation.
*EBL involves the placement of elastic circular ring ligatures around the [[varices]] to cause [[strangulation]].<ref name="pmid18818787">{{cite journal |vauthors=Zepeda-Gómez S, Marcon NE |title=Endoscopic band ligation for nonvariceal bleeding: a review |journal=Can. J. Gastroenterol. |volume=22 |issue=9 |pages=748–52 |year=2008 |pmid=18818787 |pmc=2661278 |doi= |url=}}</ref><ref name="pmid11905861">{{cite journal |vauthors=Ertekin C, Taviloglu K, Barbaros U, Guloglu R, Dolay K |title=Endoscopic band ligation: alternative treatment method in nonvariceal upper gastrointestinal hemorrhage |journal=J Laparoendosc Adv Surg Tech A |volume=12 |issue=1 |pages=41–5 |year=2002 |pmid=11905861 |doi=10.1089/109264202753486911 |url=}}</ref>
*Bands are typically delivered at the gastroesophageal junction first, then proximally six to ten bands may be delivered with a single intubation.
*Follow-up [[endoscopies]] are recommended at various intervals depending on the size/appearance of [[varices]] and severity of [[Liver diseases|liver disease]].
*Endoscopic therapy can halt bleeding in 80% to 90% of patients.
*EBL is equivalent to EIS in establishing initial control of [[bleeding]].  
*Follow-up endoscopies are recommended at various intervals depending on the size/appearance of varices and severity of liver disease.
*EBL is widely favored over EIS for primary prevention due to similar or superior efficacy with fewer [[complications]].
*EBL is equivalent to EIS in establishing initial control of bleeding.  
*The primary drawback of EBL is that during [[Bleeding|active bleeding]], operator visibility is limited by the device holding the bands prior to their delivery.
*EBL is widely favored over EIS for primary prevention due to similar or superior efficacy with fewer complications.
*The primary drawback of EBL is that during active bleeding, operator visibility is limited by the device holding the bands prior to their delivery.


===Endoscopic injection sclerotherapy (EIS)===
===Endoscopic injection sclerotherapy (EIS)===
*Comprises endoscopic delivery of a sclerosant, such as ethanol, morrhuate sodium, polidocanol, or sodium tetradecyl sulfate.
*Comprises endoscopic delivery of a sclerosant to induce fibrosis of the bleeding vessel
*Injections may be intravariceal or be delivered into the esophageal wall near the varices.
*Most common sclerosants include [[ethanol]], [[polidocanol]], and [[sodium tetradecyl sulfate]].<ref name="pmid18567095">{{cite journal |vauthors=Shi B, Wu W, Zhu H, Wu YL |title=Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol |journal=World J. Gastroenterol. |volume=14 |issue=22 |pages=3598–601 |year=2008 |pmid=18567095 |pmc=2716629 |doi= |url=}}</ref><ref name="pmid21037987">{{cite journal |vauthors=Al-Ali J, Pawlowska M, Coss A, Svarta S, Byrne M, Enns R |title=Endoscopic management of gastric variceal bleeding with cyanoacrylate glue injection: safety and efficacy in a Canadian population |journal=Can. J. Gastroenterol. |volume=24 |issue=10 |pages=593–6 |year=2010 |pmid=21037987 |pmc=2975471 |doi= |url=}}</ref>
*Bucrylate is an adhesive that has been used successfully.  
*Sclerosants are delivered intravariceally or endoscopically into the [[Esophageal|esophageal wall]] near the [[varices|bleeding varices]].
*Typical injection volume is 1 to 2 mL per injection, for a total volume of 10 to 15 mL.
*Typical 1 to 2 mL of sclerosant is sufficient to control bleeding.
*Interval between injections varies according to patient tolerance and response, and complications.
*After an initial injection follow-up injection is done weekly until complete obliteration of the [[varices]] is achieved.
*After an initial injection to control bleeding, there is usually a follow-up injection 2 to 3 days later, followed by weekly or biweekly procedures until complete obliteration of the varices is achieved, which usually takes five or six sessions.
==Second Look endoscopy==
*Second-look endoscopy refers to the practice of performing a planned follow-up endoscopy, generally within 24 hours of the initial [[endoscopy]].<ref name="pmid25674738">{{cite journal |vauthors=Tano S, Horiki N, Omata F, Tanaka K, Hamada Y, Katsurahara M, Ninomiya K, Nishikawa K, Nojiri K, Yamada R, Inoue H, Gabazza EC, Katayama N, Takei Y |title=Second and third-look endoscopy for the prevention of post-ESD bleeding |journal=Medicine (Baltimore) |volume=94 |issue=6 |pages=e491 |year=2015 |pmid=25674738 |pmc=4602741 |doi=10.1097/MD.0000000000000491 |url=}}</ref>
*The 2010 recommendations on the management of patients with nonvariceal UGIB from the International Consensus Upper Gastrointestinal Bleeding Conference Group, however, do not recommend the use of routine second-look endoscopy


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 21:16, 8 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

In UGIB, it is recommended to perform diagnostic and therapeutic endoscopy simultaneously. The common procedures used to manage upper GI bleeding caused by the peptic ulcer disease and esophageal varices are sclerotherapy (EIS), coagulation (thermal, electric, and argon plasma), hemostatic clips and variceal band ligation.

Endoscopic intervention

In UGIB, it is recommended to perform both diagnostic and therapeutic endoscopy simultaneously. Endoscopic intervention undertaken within 24 hours is not only associated with less transfusion needs but also reduced the length of stay in hospital.[1]

  • The American Society of Gastrointestinal Endoscopy guidelines recommend the use of two different endoscopic procedures, rather than a single procedure to better control bleeding and decrease the incidence of re-bleeding.[2]

Management of upper GI bleeding caused by the peptic ulcer disease

The most common procedures used to manage upper GI bleeding caused by the peptic ulcer disease are:[3][4][5]

  • Sclerotherapy (EIS)
  • Coagulation (thermal, electric, and argon plasma)
  • Hemostatic clips

Endoscopic Coagulation

  • Thermal contact probes are the mainstay of endoscopic hemostasis in upper GI bleeding.[6]
    • Contact types :Heater probe, monopolar and bipolar electrocoagulation
    • Noncontact types :Laser treatment, argon plasma coagulation 

Contact probes

  • The most commonly employed contact probe in the management of upper GI bleeding is a multipolar electrocoagulation probe.
  • With contact probes blood flow is stopped by clamping followed by induction of heat for the occlusion of the bleeding vessel.
  • The most feared complication of thermal probes is perforation of arteries and surrounding tissue.

Noncontact types

Endoscopic Hemostatic clips

  • Endoscopic hemoclips differ from surgical clips in that they do not have as much compressive strength
  • Hemostatic clips apply mechanical pressure using  a surgical scissors with a locking clamp to control the bleeding.[7]
  • Hemoclips are useful for patients with malnutrition or coagulopathy.
  • Hemoclips cannot be used in situations where bleeding site is deeper or unable to access using endoscopic procedure.

{{#ev:youtube|59uO-8UVC2A}}

Management of upper GI bleeding caused by the esophageal varices

The most common procedures used to manage esophageal varices are:[8]

  • Sclerotherapy
  • Variceal band ligation

Endoscopic band ligation (EBL)

  • EBL involves the placement of elastic circular ring ligatures around the varices to cause strangulation.[9][10]
  • Follow-up endoscopies are recommended at various intervals depending on the size/appearance of varices and severity of liver disease.
  • EBL is equivalent to EIS in establishing initial control of bleeding.
  • EBL is widely favored over EIS for primary prevention due to similar or superior efficacy with fewer complications.
  • The primary drawback of EBL is that during active bleeding, operator visibility is limited by the device holding the bands prior to their delivery.

Endoscopic injection sclerotherapy (EIS)

  • Comprises endoscopic delivery of a sclerosant to induce fibrosis of the bleeding vessel
  • Most common sclerosants include ethanol, polidocanol, and sodium tetradecyl sulfate.[11][12]
  • Sclerosants are delivered intravariceally or endoscopically into the esophageal wall near the bleeding varices.
  • Typical 1 to 2 mL of sclerosant is sufficient to control bleeding.
  • After an initial injection follow-up injection is done weekly until complete obliteration of the varices is achieved.

Second Look endoscopy

  • Second-look endoscopy refers to the practice of performing a planned follow-up endoscopy, generally within 24 hours of the initial endoscopy.[13]
  • The 2010 recommendations on the management of patients with nonvariceal UGIB from the International Consensus Upper Gastrointestinal Bleeding Conference Group, however, do not recommend the use of routine second-look endoscopy

References

  1. ↑ Garber A, Jang S (2016). "Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding". Clin Endosc. 49 (5): 421–424. doi:10.5946/ce.2016.110. PMC 5066413. PMID 27744662.
  2. ↑ Hwang, Joo Ha; Shergill, Amandeep K.; Acosta, Ruben D.; Chandrasekhara, Vinay; Chathadi, Krishnavel V.; Decker, G. Anton; Early, Dayna S.; Evans, John A.; Fanelli, Robert D.; Fisher, Deborah A.; Foley, Kimberly Q.; Fonkalsrud, Lisa; Jue, Terry; Khashab, Mouen A.; Lightdale, Jenifer R.; Muthusamy, V. Raman; Pasha, Shabana F.; Saltzman, John R.; Sharaf, Ravi; Cash, Brooks D. (2014). "The role of endoscopy in the management of variceal hemorrhage". Gastrointestinal Endoscopy. 80 (2): 221–227. doi:10.1016/j.gie.2013.07.023. ISSN 0016-5107.
  3. ↑ Fujii-Lau LL, Wong Kee Song LM, Levy MJ (2015). "New Technologies and Approaches to Endoscopic Control of Gastrointestinal Bleeding". Gastrointest. Endosc. Clin. N. Am. 25 (3): 553–67. doi:10.1016/j.giec.2015.02.005. PMID 26142038.
  4. ↑ Laine L, McQuaid KR (2009). "Endoscopic therapy for bleeding ulcers: an evidence-based approach based on meta-analyses of randomized controlled trials". Clin. Gastroenterol. Hepatol. 7 (1): 33–47, quiz 1–2. doi:10.1016/j.cgh.2008.08.016. PMID 18986845.
  5. ↑ Park CH, Lee SJ, Park JH, Park JH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ (2004). "Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding". Gastrointest. Endosc. 60 (6): 875–80. PMID 15605000.
  6. ↑ Szura M, Pasternak A (2015). "Upper non-variceal gastrointestinal bleeding - review the effectiveness of endoscopic hemostasis methods". World J Gastrointest Endosc. 7 (13): 1088–95. doi:10.4253/wjge.v7.i13.1088. PMC 4580950. PMID 26421105.
  7. ↑ Albert JG, Peiffer KH (2016). "[New methods for endoscopic hemostasis: focus on non-variceal gastrointestinal bleeding]". Z Gastroenterol (in German). 54 (3): 250–5. doi:10.1055/s-0035-1566987. PMID 26894683.
  8. ↑ Cook DJ, Guyatt GH, Salena BJ, Laine LA (1992). "Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis". Gastroenterology. 102 (1): 139–48. PMID 1530782.
  9. ↑ Zepeda-Gómez S, Marcon NE (2008). "Endoscopic band ligation for nonvariceal bleeding: a review". Can. J. Gastroenterol. 22 (9): 748–52. PMC 2661278. PMID 18818787.
  10. ↑ Ertekin C, Taviloglu K, Barbaros U, Guloglu R, Dolay K (2002). "Endoscopic band ligation: alternative treatment method in nonvariceal upper gastrointestinal hemorrhage". J Laparoendosc Adv Surg Tech A. 12 (1): 41–5. doi:10.1089/109264202753486911. PMID 11905861.
  11. ↑ Shi B, Wu W, Zhu H, Wu YL (2008). "Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol". World J. Gastroenterol. 14 (22): 3598–601. PMC 2716629. PMID 18567095.
  12. ↑ Al-Ali J, Pawlowska M, Coss A, Svarta S, Byrne M, Enns R (2010). "Endoscopic management of gastric variceal bleeding with cyanoacrylate glue injection: safety and efficacy in a Canadian population". Can. J. Gastroenterol. 24 (10): 593–6. PMC 2975471. PMID 21037987.
  13. ↑ Tano S, Horiki N, Omata F, Tanaka K, Hamada Y, Katsurahara M, Ninomiya K, Nishikawa K, Nojiri K, Yamada R, Inoue H, Gabazza EC, Katayama N, Takei Y (2015). "Second and third-look endoscopy for the prevention of post-ESD bleeding". Medicine (Baltimore). 94 (6): e491. doi:10.1097/MD.0000000000000491. PMC 4602741. PMID 25674738.
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