New Endoscopic Hemostasis Methods.
- Author:
En Ling LEUNG KI
1
;
James Y W LAU
Author Information
1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
- Publication Type:Comparative Study ; Review
- Keywords:
Endoscopic haemostasis;
Upper gastrointestinal bleeding
- MeSH:
Aged;
Arteries;
Endosonography;
Epinephrine;
Hemorrhage;
Hemostasis;
Hemostasis, Endoscopic;
Humans;
Hypotension;
Minerals;
Torque;
Ulcer
- From:Clinical Endoscopy
2012;45(3):224-229
- CountryRepublic of Korea
- Language:English
-
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.
