Contact thermal devices for the treatment of bleeding peptic ulcers
- John R Saltzman, MD, FACP, FACG, FASGE, AGAF
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
- Section Editor — Therapeutic and Diagnostic Endoscopy
- Professor of Medicine
- Harvard Medical School
The treatment of bleeding peptic ulcers includes resuscitation, treatment with acid suppressive therapy, and application of endoscopic therapy for patients at high risk of ongoing or recurrent bleeding (table 1). Several endoscopic approaches can be used to treat bleeding peptic ulcers, including use of contact thermal devices, endoscopic hemoclips, and epinephrine injection.
This topic will review the use of contact thermal devices for the treatment of bleeding peptic ulcers. An overview of the treatment of bleeding peptic ulcers, issues to consider when deciding which specific endoscopic therapies to use, and treating bleeding ulcers with endoscopic hemoclips, epinephrine injection, or argon plasma coagulation are discussed elsewhere. (See "Approach to acute upper gastrointestinal bleeding in adults" and "Overview of the treatment of bleeding peptic ulcers" and "Endoclip therapy in the gastrointestinal tract: Bleeding lesions and beyond", section on 'Bleeding peptic ulcers' and "Argon plasma coagulation in the management of gastrointestinal hemorrhage".)
Contact thermal therapy is one option for treating ulcers with stigmata of recent hemorrhage (table 2) . It can also be used to treat patients with bleeding from Dieulafoy's lesions, Mallory-Weiss tears, and gastric antral vascular ectasias. (See "Overview of the treatment of bleeding peptic ulcers", section on 'Endoscopic therapy' and "Causes of upper gastrointestinal bleeding in adults", section on 'Specific causes'.)
The appearance of ulcers can be described using the Forrest classification :
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- AVAILABLE DEVICES
- Multipolar probes
- Heater probe
- Monopolar probe
- USE IN PATIENTS WITH IMPLATED CARDIAC PACEMAKERS OR DEFIBRILATORS
- - Choice of endoscope
- - Choice of probe
- - Use of Doppler ultrasound
- Application of thermal coagulation
- - Active bleeding or a nonbleeding visible vessel
- - Nonbleeding adherent clots
- SUMMARY AND RECOMMENDATIONS