New Endoscopic Technologies and Procedural Advances for Endoscopic Hemostasis

Abstract

Endoscopic interventions are first-line therapy for upper and lower gastrointestinal bleeding. Injection therapy in combination with a second endoscopic modality has reduced re-bleeding, need for surgery and mortality in non-variceal bleeding. For variceal bleeding endoscopic banding or cyanoacrylate injection techniques are recommended interventions. However, despite ease of application and general acceptance of these techniques, there is an ongoing re-bleeding rate associated with significant in-hospital mortality. We discuss current literature on new advances in endoscopic technologies and procedural techniques that have emerged to improve patient outcomes.

Endoscopic closure devices: A review of technique and application for hemostasis

“…Although there are clear benefits to through the scope clips, the size and shallow depth of these clips are a major limitation for their application in densely fibrotic ulcer beds, large or awkwardly positioned bleeding lesions. 56 For these reasons, OTSC have an advantage and are capable of achieving hemostasis with reduced rates of rebleeding, in comparison to TTS clips and other traditional methods. 28 While these OTSC clips offer larger tissue depth and higher compression strength, only a few small studies advocate their use as primary intervention.…”

Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future

“…However, the process of determining the exact feeding vessel was described as difficult and time consuming. Their technique necessitated the injection of contrast medium prior to glue to ensure that the afferent feeding vessel was correctly selected [13]. …”

“…They postulated that the use of the coil would give the CYA a scaffold on which to form, minimising the amount of glue required and the risk of embolization [13]. They evaluated combination therapy in 30 patients with gastric varices >1 cm that were not good candidates for transjugular intrahepatic portosystemic shunt (TIPSS).…”

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

“…Depending on the location and type of bleeding, different hemostasis techniques have been developed, such as: injection, hemoclips, thermocoagulation, cyanoacrylate, etc. However, despite the numerous techniques, in approximately 10-30% of cases hemostasis cannot be achieved and 5-10% have bleeding recurrence [8,9].…”