Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)

Abstract

Background Endoscopic intervention is often the first line of therapy for GI nonvariceal bleeding. Although some of the devices and techniques used for this purpose have been well studied, others are relatively new, with few available outcomes data. Methods In this document, we review devices and techniques for endoscopic treatment of nonvariceal GI bleeding, the evidence regarding their efficacy and safety, and financial considerations for their use. Results Devices used for endoscopic hemostasis in the GI tract can be classified into injection devices (needles), thermal devices (multipolar/bipolar probes, hemostatic forceps, heater probe, argon plasma coagulation, radiofrequency ablation, and cryotherapy), mechanical devices (clips, suturing devices, banding devices, stents), and topical devices (hemostatic sprays). Conclusions Endoscopic evaluation and treatment remains a cornerstone in the management of nonvariceal upper- and lower-GI bleeding. A variety of devices is available for hemostasis of bleeding lesions in the GI tract. Other than injection therapy, which should not be used as monotherapy, there are few compelling data that strongly favor any one device over another. For endoscopists, the choice of a hemostatic device should depend on the type and location of the bleeding lesion, the availability of equipment and expertise, and the cost of the device.

Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report

“…Despite the variety of treatment modalities, re-bleeding is common. 8 The use of SEMS in refractory esophageal variceal bleeding has been studied in a randomized controlled setting. 8 – 10 In contrary to this, only a few case reports and a case series described the use of SEMS to achieve hemostasis in malignant upper GI tumors.…”

“… 8 The use of SEMS in refractory esophageal variceal bleeding has been studied in a randomized controlled setting. 8 – 10 In contrary to this, only a few case reports and a case series described the use of SEMS to achieve hemostasis in malignant upper GI tumors. Three case reports showed failure to stop bleeding from ulcerated esophageal and duodenal tumors, using the conventional endoscopic interventions, but resulted in immediate cessation of bleeding after placement of FCSEMS.…”

The role of endoscopy as non-invasive procedure to manage gastrointestinal complications during extracorporeal membrane oxygenation

“…Thanks to advancements in endoscopic equipment and management, effective minimally invasive techniques are feasible and applicable, even in the presence of severe GI bleeding. 24,31 Previously, endoscopists may have achieved effective hemostasis by combining different types of hemostatic therapy or using various devices with other specific applications. In fact, our first and only case of recurrent bleeding prior to 2011 was effectively treated by the combination of clips and Endoloop (Olympus Europe) thanks to the mechanical traction and tangential force of the clips and the Endoloop itself, though this latter device is commonly used as a prophylactic maneuver for post-endoscopic resection bleeding.…”

A case of the lower gastrointestinal bleeding due to Dieulafoy’s ulcer in the cecum

“…Methods of mechanical hemostasis such as endoscopic clips or band ligation are reportedly better than injection of sclerosants in terms of the number of treatments and the effects of rebleeding suppression [ 20 – 22 ]. Recently, electrical hemostatic forceps are often used for the treatment of GI bleeding and many articles have been reported about the usefulness of hemostatic forceps [ 23 – 26 ]. With colonic lesions, clinicians must beware of the greater risk of perforation, especially rebleeding after thermocoagulation, because of the thinness of the colonic wall compared with the stomach.…”