Clin Endosc.  2012 Sep;45(3):224-229.

New Endoscopic Hemostasis Methods

• Leung Ki E
• Lau JY

Abstract

Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension.

Keyword

Endoscopic haemostasis; Upper gastrointestinal bleeding

MeSH Terms

Aged
Arteries
Endosonography
Epinephrine
Hemorrhage
Hemostasis
Hemostasis, Endoscopic
Humans
Hypotension
Minerals
Torque
Ulcer
Epinephrine
Minerals

Figure

• 

  Fig. 1 A forest plot of a meta-analysis that compared mono- to dual endoscopic therapies in the treatment of non-variceal upper gastrointestinal bleeding (modified from Marmo et al. Am J Gastroenterol 2007;102:279-289).3 CI, confidence interval.

• 

  Fig. 2 Hemospray treatment of a bleeding gastric ulcer; short bursts of powder were sprayed onto the ulcer (A-C). On follow-up endoscopy at day 3, a flat pigment was seen on the ulcer crater (D).

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  Fig. 3 An actively bleeding duodenal ulcer was over-sewn with the overstitch device (A-D). Three stitches were applied.

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  Fig. 4 A large bulbar ulcer that failed hemoclipping (A) was treated by thermo-coagulation using a 3.2 mm heater probe (B, C). The gastroduodenal artery was then coiled during angiography (D). The picture depicts a microcatheter in the common hepatic artery and a larger Simmon's catheter in the celiac artery. The hemoclips provide landmark to the site for empirical coiling. Coils are first dropped distal to the bleeding point. Gelfoams are then used to block collateral branches. Further coils are then added to the proximal portion of the gastro-duodenal artery.

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