Endoscopic management of serious non-variceal upper GI bleeding with local injection therapy

Massive non-variceal upper GI bleeding is a very common and serious problem. especially if bleeding comes from a vessel. In these circumstances, unless therapeutic endoscopy or emergency surgery is per-formed, the bleeding may lead to a very high mortality. Endoscopic injection therapy can be performed by injecting diluted epinephrine [1:10,000] or normal saline; alone or with a sclerosant. Adding a sclerosant is preferred if the bleeding is massive or has a spurt pattern. This technique proved to be highly effective and safe and almost comparable to other types of therapeutic endoscopies like bipolar electro-coagulator (BICAP) heat probe or laser photocoagulation therapy. The clinical studies performed in this field, the technique of injection and the types and amount of the substance to be injected will be discussed in details.