New Technologies and Approaches to Endoscopic Control of Gastrointestinal Bleeding

Acute upper gastrointestinal bleeding: A stitch on time saves nine

Upper gastrointestinal bleeding is common and often needs timely intervention for optimal outcomes. Esophageal bleeding may occur due to local advancement of malignancy or bleeding from an arterio-oesophageal fistula. We discuss the management options available for such cases.

Experimental Substantiation of Autoplasma Application as a Haemostatic Agent in Endoscopic Operations in the Digestive Tract

Introduction. In endosurgery of the digestive tract, ‘cellular technologies’ are gaining popularity, including the use of blood components or blood cells with a haemostatic purpose. In this regard, the objective of the study is evaluation of the effectiveness of bleeding control and safety of resection of the hollow organs of the digestive tract in the experimental trauma models of the abdominal organs in laboratory animals.

Materials and methods. The study was conducted in 20 mature male Chinchilla rabbits with the mean body mass of 2450 ± 210 g. All animals were divided into four experimental groups: the control group (without bleeding control); the group that received the infiltration of the wall of a hollow organ with saline; the group in which bleeding was controlled by argon plasma coagulation (APC), and the group wherein animals underwent haemostasis with autoplasma.

Results. In the control group and the physiological saline group, no statistical difference was observed in the time of bleeding control. Autoplasma, due to preventive local administration, is more effective than APC and has a high haemostatic potential.

Conclusion. Autoplasma has been found to be highly effective and safe for bleeding control in the gastrointestinal tract in the experimental model, which has paved the way for new possibilities for operations of various scales, including endoscopic operations.

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

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.

Recent Developments in the Endoscopic Treatment of Patients with Peptic Ulcer Bleeding

Peptic ulcer bleeding is an internal medical emergency. Endoscopic hemostasis has been shown to improve the survival rate of patients with peptic ulcer bleeding. Although the established hemostatic modalities, including injection, thermal therapy, and mechanical therapy, are effective in controlling peptic ulcer bleeding, hemostasis can be difficult to achieve in some cases. As a result, recent, new endoscopic hemostatic modalities, including over-the-scope clips, topical hemostatic sprays, and endoscopic ultrasonography-guided angiotherapy, have been developed.