Mechanical methods to endoscopically treat nonvariceal upper gastrointestinal bleeding

Abstract Acute upper gastrointestinal bleeding (UGIB) is a frequent condition worldwide. The most common causes of acute nonvariceal UGIB include ulcers and nonulcer etiology, such as mucosal erosive disease, Mallory-Weiss tear, Dieulafoy, and other vascular lesions. Today patients are older and more likely to have comorbidities and concomitant treatments: anticoagulants, antiplatelet agent, low dose aspirin or steroidal anti-inflammatory drugs. In these patients with UGIB the rebleeding risk, need for surgery, and mortality rates are higher. Mechanical therapy using through-the-scope clips leads to a substantially reduced rebleeding risk and requirement for surgery compared with injections alone. The addition of injection therapy to mechanical treatment confers no further clinical advantage; clip compared with thermocoagulation had no improvement in definitive hemostasis, surgery or death, alone or in combination with injection. In patients with Dieulafoy or angiodysplasia or both, clipping and endoscopic band ligation are more effective and successful in achieving hemostasis when compared to injection. The available data are insufficient to consider over-the-scope clip as second-line therapy after the failure of conventional endoscopic treatment.