B0313 - Use of an Endoscopic Doppler Probe by General Gastroenterologists and Trainees to Guide Hemostasis in Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB): Outcomes of a Large Academic Medical Center

Sue Dong, MD, Saif Laljee, MD, Kimberly Cheng, MD, Philip Burkhard, BS, Melissa Latorre, MD, MS
New York University Langone Medical Center, New York, NY

Introduction: Visual assessment of stigmata of hemorrhage in NVUGIB is the cornerstone of endoscopic therapy. Nevertheless, rebleeding occurs in up to 30% of patients. The endoscopic doppler probe (EDP) is a novel device that can help guide hemostasis by assessing for arterial blood flow (ABF) within an ulcer base despite its visual appearance. It is most helpful when there is ambiguous stigmata or discordance between the stigmata and clinical picture. Ulcers with residual ABF flow following treatment have been associated with higher rates of rebleeding. The use of EDP to confirm eradication of ABF improves rebleeding. Use of the EDP has not been widely adopted. We seek to evaluate the outcomes in hemostasis with use of EDP after competency training of general gastroenterology (GI) attendings and trainees by our GI hospitalist.

Methods: We performed a retrospective study of patients admitted to a large quaternary care academic medical center with NVUGIB for whom EDP was used during endoscopy (EGD) before and/or after endoscopic treatment. Procedures were performed between January 2021 and May 2022 and were supervised by 4 gastroenterology attendings. Patient demographics and outcomes are listed in Table 1. The primary outcome was 30-day rebleeding rate, defined as clinical evidence of bleeding plus need for repeat endoscopy or other therapeutic intervention at the location of initial hemostasis as guided by EDP.

Results: We identified 37 patients who underwent EGD with EDP. We found a 30-day rebleeding rate of 13.5% (n = 5). Patients who rebled were more likely to be of Hispanic heritage and previously treated with bipolar cautery (p< 0.05). There were no other significant differences (Table 1). Most ulcers were located within the duodenum (67.6%, n = 25), and most were large ( > 10mm in size; 75.7%, n = 28). In 4 patients use of the EDP did not lead to additional endoscopic treatment. None of these patients had rebleeding. For the patients with rebleeding 1 patient required EGD and angiography; 2 patients required repeat EGD only and 2 patients underwent angiography only. No patients required surgery. No intraprocedural complications were identified.

Discussion: The EDP is a highly effective tool in the management of NVUGIB and can be safely and successfully used by general GI attendings and trainees. The EDP provides a treat-to-target approach to hemostasis and improves upon standard visual assessment of stigmata of hemorrhage. Training in EDP should be encouraged in physicians who treat NVUGIB.



Disclosures:


Sue Dong, MD, Saif Laljee, MD, Kimberly Cheng, MD, Philip Burkhard, BS, Melissa Latorre, MD, MS. B0313 - Use of an Endoscopic Doppler Probe by General Gastroenterologists and Trainees to Guide Hemostasis in Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB): Outcomes of a Large Academic Medical Center, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.