CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(12): E1439-E1444
DOI: 10.1055/a-0749-0011
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

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

Amol Agarwal*
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Petros Benias*
2  Division of Gastroenterology, North Shore-Long Island Jewish Medical Center, Queens, NY
,
Olaya I. Brewer Gutierrez
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Vivien Wong
3  Department of Surgery, Chinese University of Hong Kong, Hong Kong
,
Yuri Hanada
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Juliana Yang
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Vipin Villgran
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Vivek Kumbhari
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Anthony Kalloo
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Mouen A. Khashab
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
,
Philip Chiu
3  Department of Surgery, Chinese University of Hong Kong, Hong Kong
,
Saowanee Ngamruengphong
1  Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
› Author Affiliations
Further Information

Publication History

submitted 30 June 2018

accepted after revision 30 August 2018

Publication Date:
10 December 2018 (online)

  

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.

* These authors contributed equally.