Endoscopic Hemostasis in Nonvariceal Upper Gastrointestinal Bleeding: Comparison of Physician Practice in the East and the West

Background Endoscopic hemostasis is commonly practiced during GI endoscopy practice. We hypothesized that, because the choice of endoscopic intervention is influenced by many factors, for example personal experience, prior training, guidelines, etc., there would be differences in practice patterns among different groups of endoscopists. Objective To explore the potentially different practices for endoscopic hemostasis between the "East" (eight Asian countries) and the "West" (USA and Canada). Design Cross-sectional descriptive study (internet-based survey). Study subjects We administered a questionnaire survey to American Society of Gastrointestinal Endoscopy (ASGE) and Korean Society of Gastroenterology (KSGE) members (see: http://www4.utsouthwestern.edu/inetdemo/endoscopy/hemostasis.html, or supplementary paper for review online). Results Eastern ASGE members (n = 112) were more likely to complete this survey than ASGE members in the West (n = 180): 15.1 vs. 5.0%, P < 0.001. Choice of hemostatic method, regardless of primary or recurrent bleeding, varied significantly among Eastern and Western endoscopists. For example, for treatment of a gastric ulcer with a visible vessel, a vast majority (70%) of Western endoscopists preferred pre-injection followed by thermocoagulation whereas responses from the East were more diverse, with endoclip application +/- A pre-injection being the top choice (29%) (P < 0.001). Personal EGD volume and hospital bed numbers did not seem to be associated with hemostatic choices in either the East or the West. Conclusions Endoscopic hemostasis practice patterns for upper GI tract bleeding differed among Eastern and Western endoscopists, suggesting fundamental differences in practice habit determinants.