Endoscopic Control of Bleeding Ulcer

The following are “Does” from the syllabus

• Endoscopic assessment: - elective - emergency (of peptic ulcer disease)

• Techniques of endoscopic haemostasis

• Grade with Forrest Classification

• 90% successful, use dual therapy

  • Adrenaline injection (1 in 10,000)
    • Primary haemostasis rates high
    • Causes vasoconstriction and tamponade
    • But up to 30% rebleed if used alone - don’t use as monotherapy
  • Clips
  • Coagulation/APC
    • Contact probes (heater probe, bipolar electrocoagulation)
    • Coaptive coagulation of the bleeding vessel
    • Non-contact (argon plasma coagulation) used for diffuse oozing
  • Fibrin sealants/haemostatic agents
    • Hemospray (hemostatic powder) to tamponade diffuse or inaccessible bleeding

• Dual therapy (adrenaline and another) has relative risk of re-bleed compared to monotherapy of 0.3