New endoscopic techniques in treating gastrointestinal bleeding

ABSTRACT

Gastrointestinal (GI) bleeding is a common disorder encountered in an emergency department or primary clinical setting. The therapeutic basis for GI bleeding is endoscopic hemostasis. To date, epinephrine injection, through-the-scope clips, monopolar or biopolar coagulation, and band ligation have been established for GI bleeding. Despite the advances in endoscopic techniques, we often experience re-bleeding associated with significant inhospital mortality in GI bleeding. New devices that complement the disadvantages of these conventional endoscopic techniques have recently been introduced. For example, over-the-scope clip, which has wider and stronger pressure than conventional mechanical devices, can ligate a wide range of surrounding mucous membranes and has been reported to be effective in severe lesions of fibrosis. In addition, hemostatic powders achieved successful hemostasis as primary or rescue therapy in several cases of GI bleeding. Successful application of these new techniques requires appropriate patient selection and understanding of the device and further research is expected in the future.