Endoscopic haemostasis: An overview of procedures and clinical scenarios

Abstract

Acute gastrointestinal bleeding is among the most urgent situations in daily gastroenterological practise. Endoscopy plays a key role in the diagnosis and treatment of such cases. Endoscopic haemostasis is probably the most important technical challenge that must be mastered by gastroenterologists. It is essential for both the management of acute gastrointestinal haemorrhage and the prevention of bleeding during high-risk endoscopic procedures. During the last decade, endoscopic haemostasis techniques and tools have grown in parallel with the number of devices available for endotherapy. Haemostatic powders, over-the-scope clips, haemostatic forceps, and other emerging technologies have changed daily practise and complement the standard available armamentarium (injectable, thermal, and mechanical therapy). Although there is a lack of strong evidence-based information on these procedures because of the difficulty in designing statistically powerful trials on this topic, physicians must be aware of all available devices to be able to choose the best haemostatic tool for the most effective procedure. We herein present an overview of procedures and clinical scenarios to optimise the management of gastrointestinal bleeding in daily practise.

New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

“…The success of other strategies such as argon plasma coagulation, cyanoacrylate injection, Hemospray ® , and ABS ® in stopping bleeding from Dieulafoy's lesion has been also reported (50,58,62,63).…”

Hemospray® during Emergency Endoscopy: Indonesia’s First Experience from 37 Patients

“…Recently, hemostatic spray powder has been developed. It consists of inorganic powder that acts as cohesive and adhesive when it is in contact with moisture on the mucosa to make a mechanical barrier and seal the bleeding [10]. The powder is neither absorbed nor metabolized, therefore reducing the risk of toxicity [9].…”

Postpolypectomy prophylactic clip closure for the prevention of delayed postpolypectomy bleeding: A systematic review

“…Several techniques, including epinephrine–saline solution and use of detachable nylon loop, are used prior to polypectomy to reduce the risk of hemorrhage. Significant immediate postpolypectomy bleeding can usually be controlled by application of hemostatic clips, with a high success rate . However, delayed postpolypectomy bleeding (DPPB), defined as per rectal bleeding that occurs after completion of colonoscopy, poses serious clinical concerns, particularly when it occurs outside of hospitals as it can be associated with a relatively large volume blood loss and delay in appropriate treatment .…”

“…Significant immediate postpolypectomy bleeding can usually be controlled by application of hemostatic clips, with a high success rate. 12,13 However, delayed postpolypectomy bleeding (DPPB), defined as per rectal bleeding that occurs after completion of colonoscopy, poses serious clinical concerns, particularly when it occurs outside of hospitals as it can be associated with a relatively large volume blood loss and delay in appropriate treatment. 3 Hospital readmission, transfusion, repeat endoscopy, and-rarelyradiological or surgical intervention may be required.…”