We thank Dr Moreels for his comments regarding the use of the large funnel-shaped cap for the removal of large blood clots during upper GI bleeding. Intravenous erythromycin is a demonstrated and relatively simple strategy for motility of large blood clots in the stomach, as recently published in an international consensus on upper GI bleeding.
1
The consensus did not describe the use of large caps in this setting, and the referenced Belgian guidelines2
only marginally mentioned their use along with other suction devices when erythromycin is not effective. Erythromycin and large-channel endoscopes or other direct suction devices are simple and effective at clot removal in upper GI bleeding and do not require routine endotracheal intubation. When the simple steps are not available or effective for clot removal, then other tools and techniques, such as large caps, could be considered.References
- International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding.Ann Intern Med. 2010; 152: 101-113
- Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children.Acta Gastroenterol Belg. 2011; 74: 45-66
Article info
Identification
Copyright
© 2013 Published by Elsevier Inc.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The endoscopic cap and upper GI bleedingGastrointestinal EndoscopyVol. 77Issue 1
- PreviewI read the technical review on the use of endoscopic caps by Sanchez-Yague et al1 with great interest. The authors review the usefulness of available cap types attached to the endoscope tip for several diagnostic and therapeutic procedures throughout the GI tract. Cap use facilitates treatment of GI bleeding because it can improve the reach, visualization, and hemostasis of the bleeding site. Although the authors also mention the usefulness of a cap to suction foreign bodies or mucosal tissue, the use of a cap to remove large blood clots from the stomach was not dealt with.
- Full-Text
- Preview
