Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience

Amol Agarwal; Petros Benias; Olaya I. Brewer Gutierrez; Vivien Wong; Yuri Hanada; Juliana Yang; Vipin Villgran; Vivek Kumbhari; Anthony Kalloo; Mouen A. Khashab; Philip Chiu; Saowanee Ngamruengphong

doi:10.1055/a-0749-0011

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(12): E1439-E1444
DOI: 10.1055/a-0749-0011

Original article

Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience

Authors

Amol Agarwal^*

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Petros Benias^*

²Division of Gastroenterology, North Shore-Long Island Jewish Medical Center, Queens, NY
Olaya I. Brewer Gutierrez

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Vivien Wong

³Department of Surgery, Chinese University of Hong Kong, Hong Kong
Yuri Hanada

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Juliana Yang

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Vipin Villgran

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Vivek Kumbhari

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Anthony Kalloo

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Mouen A. Khashab

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
Philip Chiu

³Department of Surgery, Chinese University of Hong Kong, Hong Kong
Saowanee Ngamruengphong

¹Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD

Abstract

Background and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown.

Patients and methods This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs).

Results Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing.

Conclusions Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding.

Full Text

References

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