Therapeutic Endoscopy for the Control of Non-Variceal Upper Gastrointestinal Bleeding in Children: A Case Series.

Introduction: Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with very few performed for non-variceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are very sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows' training opportunities according to the national training guidelines. Methods: We performed a retrospective review of endoscopy database (Endoworks(R), Olympus Inc., Center Valley, PA) from January 2009 to December 2014. The search utilized the following keywords bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included: demographics, description of bleeding lesion and medical/endoscopic therapy, rate of re-bleeding, relevant laboratories, physical exam, and need for transfusion and surgery. The study was approved by the Institutional Review Board. Results: During the study period 12,737 upper endoscopies (EGDs) were performed. A total of 15 patients underwent 17 EGDs that required therapeutic intervention to control bleeding (1:750 procedures). The mean +/- SD (median) age of patients that required endoscopic intervention was 11.6 +/- 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and three received octreotide infusions. Six of the patients experienced re-bleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration, perforation, or deaths. There were a total of 24 fellows trained in our program during the study period. Less than one therapeutic endoscopy per fellow for NVUGI bleeding was performed. Conclusions: Non-variceal upper GI bleeding requiring therapeutic endoscopic intervention is very rare in pediatrics. A high rate (40%) of re-bleeding was noted with a large proportion (66%) of patients receiving single modality therapy. Two patients required surgical intervention to control bleeding and both presented with bleeding duodenal ulcers. An insufficient number of therapeutic procedures is available for adequate fellow training requiring supplemental simulator and hands-on animal model, or adult endoscopy unit training. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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