Endoscopic vacuum therapy for the management of nonvariceal upper gastrointestinal bleeding: a valuable resource for the endoscopist’s toolbox

Abstract

Background

Endoscopic vacuum therapy (EVT) is a well-established method for managing gastrointestinal perforations. During the COVID pandemic, case reports demonstrated the effective use of EVT in controlling COVID-related diffuse duodenal bleeding. Owing to its unique mechanism of action, this approach may also be effective for other types of nonvariceal upper gastrointestinal bleeding (NVUGIB). This study aimed to assess EVT in the treatment of NVUGIB.

Methods

This retrospective analysis of a prospectively collected database included patients who underwent EVT for the treatment of NVUGIB. The primary outcome was clinical success. Secondary outcomes included technical success and safety. Subgroup analysis comparing the outcomes for patients with and without COVID was conducted.

Results

19 patients underwent EVT for NVUGIB, with 57.9% having failed other therapies. Technical success occurred in all patients, and clinical success was achieved in 89.5%. There was no difference in the clinical success rates between patients with or without COVID (88% versus 91%, respectively). No procedure-related adverse events occurred.

Conclusion

EVT appears to be safe and effective in the management of NVUGIB. This approach could be particularly useful in refractory or diffuse bleeding. Larger studies are warranted to validate these findings.

• References

• 1 Oakland K. Changing epidemiology and etiology of upper and lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2019; 42-43 101610
• 2 Liu K, Gao L, Bai JW. et al. Efficacy of new hemostatic techniques in nonvariceal gastrointestinal bleeding: A systematic review and network meta-analysis. J Dig Dis 2023; 24: 181-193
• 3 de Rezende DT, Brunaldi VO, Bernardo WM. et al. Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1704-E1713
• 4 de Moura DTH, Hirsch BS, McCarty TR. et al. Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects. Dig Endosc 2023; 35: 745-756
• 5 Luttikhold J, Pattynama LMD, Seewald S. et al. Endoscopic vacuum therapy for esophageal perforation: a multicenter retrospective cohort study. Endoscopy 2023; 55: 859-864
• 6 de Moura DTH, de Moura EGH, Hirsch BS. et al. Endoscopic vacuum therapy for duodenal hemorrhage in critically ill patients with COVID-19. Am J Gastroenterol 2022; 117: 688
• 7 de Moura DTH, de Moura EGH, Hirsch BS. et al. Modified endoscopic vacuum therapy for duodenal hemorrhage in patients with severe acute respiratory syndrome coronavirus 2. Endoscopy 2022; 54 (Suppl. 02) E837-E839
• 8 Cappell MS, Friedel DM. Gastrointestinal bleeding in COVID-19-infected patients. Gastroenterol Clin North Am 2023; 52: 77-102
• 9 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085.e8
• 10 de Moura DTH, do Monte Junior ES, Hathorn KE. et al. Modified endoscopic vacuum therapy in the management of a duodenal transmural defect. Endoscopy 2021; 53: E17-E18
• 11 de Moura DTH, Hirsch BS, Do Monte Junior ES. et al. Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages. VideoGIE 2021; 6: 523-528
• 12 Kempenich JW, Sirinek KR. Acid peptic disease. Surg Clin North Am 2018; 98: 933-944
• 13 Jiang S, Yan P, Ma Z. et al. Outcomes of COVID-19 patients undergoing extracorporeal membrane oxygenation: A systematic review and meta-analysis. Perfusion 2025; 40: 36-48
• 14 Mullady DK, Wang AY, Waschke KA. AGA Clinical Practice Update on endoscopic therapies for non-variceal upper gastrointestinal bleeding: expert review. Gastroenterology 2020; 159: 1120-1128
• 15 Lau JYW, Li R, Tan CH. et al. Comparison of over-the-scope clips to standard endoscopic treatment as the initial treatment in patients with bleeding from a nonvariceal upper gastrointestinal cause: a randomized controlled trial. Ann Intern Med 2023; 176: 455-462
• 16 Gralnek IM, Stanley AJ, Morris AJ. et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021. Endoscopy 2021; 53: 300-332
• 17 Barkun AN, Almadi M, Kuipers EJ. et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med 2019; 171: 805-822
• 18 Deliwala SS, Chandan S, Mohan BP. et al. Hemostatic spray (TC-325) vs. standard endoscopic therapy for non-variceal gastrointestinal bleeding: A meta-analysis of randomized controlled trials. Endosc Int Open 2023; 11: E288-E295
• 19 Dunne CL, Kaur S, Delacruz B. et al. 30-day readmission rates among upper gastrointestinal bleeds: A systematic review and meta-analysis. J Gastroenterol Hepatol 2023; 38: 692-702
• 20 de Moura DTH, Hirsch BS, Ribas PHBV. et al. Endoscopic vacuum therapy: pitfalls, tips and tricks, insights, and perspectives. Transl Gastroenterol Hepatol 2024; 9: 50