Endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding - Strategies in difficult cases

Hiroyuki Imaeda, Naoki Hosoe, Kazuhiro Kashiwagi, Hideki Ohgo, Minoru Yamaoka, Tomohisa Sujino, Nagamu Inoue, Hidekazu Suzuki, Yasushi Iwao, Toshifumi Hibi, Haruhiko Ogata

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Endoscopic hemoclipping using short clips is the first choice of therapy for nonvariceal upper gastrointestinal bleeding in our department. In cases where lesions exhibit massive bleeding, or bleeding from large visible vessels, or in cases where hemostasis by hemoclipping proves insufficient, combination therapy including endoscopic injection of hypertonic saline with epinephrine or diluted epinephrine is performed. A transparent hood is useful for lesions that are difficult to keep a good view or tangent lesions in which hemostasis is difficult. An endoscope with a water jet is also useful for the detection of bleeding points, thus enabling rapid hemostasis. Although the development of endoscopic procedures and instruments enables us to achieve endoscopic hemostasis in the majority of cases with peptic ulcer bleeding, there are a few difficult cases such as those of bleeding from larger arteries present in deep ulcers. When endoscopic hemostasis fails, endoscopists should closely coordinate with radiologists and surgeons from an early stage, and interventional radiology or surgery should be performed without any delay.

Original languageEnglish
Pages (from-to)2256-2268
Number of pages13
Issue number8
Publication statusPublished - 2012 Aug 1

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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