Role of endoscopy in rare causes of upper gastrointestinal bleeding: a comprehensive narrative review

Background Upper gastrointestinal bleeding (UGIB) is a critical medical and surgical emergency that can result in significant morbidity and mortality on a global scale. Endoscopy has long emerged as an essential tool for diagnosing and managing UGIB, offering diagnostic and therapeutic capabilities. However, its effectiveness in identifying and treating rare causes of bleeding is not always fully understood, particularly in instances where conventional diagnostic methods do not yield conclusive results. This comprehensive narrative review seeks to explore the role of endoscopy in diagnosing, treating and managing rare UGIB cases and emphasises recent advancements, diagnostic algorithms and therapeutic strategies in this area. Methods A thorough search was conducted across multiple databases using targeted keywords and search terms. Relevant studies focusing on the diagnostic and therapeutic roles of endoscopy in rare causes of UGIB were selected. This included case reports, case series, retrospective studies and prospective studies, all of which were analysed for clinically significant information. Results The review discussed seven rare causes of UGIB, including Dieulafoy’s lesion, gastric antral vascular ectasia, aortoenteric fistula, Cameron lesions, idiopathic non-cirrhotic portal hypertension, hepatic arterioportal fistula and haemosuccus pancreaticus. It also discussed specific endoscopic techniques for these conditions, as well as various modalities that have been reported to enhance diagnostic accuracy and improve therapeutic outcomes in these complex and rare cases. Conclusions Specific endoscopic modalities are essential for the accurate diagnosis and management of rare causes of UGIB, and maintaining a high clinical suspicion is paramount for achieving optimal outcomes.