Hemostatic Strategies for Upper Gastrointestinal Bleeding Continue to Evolve

Future strategies for managing upper gastrointestinal bleeding will likely combine existing hemostatic techniques and enhanced endoscopic imaging, advised a review article published in the World Journal of Gastroenterology.

The comprehensive review covered a variety of therapeutic interventions for upper gastrointestinal bleeding that aim to halt acute bleeding episodes and prevent rebleeding. A multimodal approach that involves endoscopic, pharmacologic, angiographic, and surgical approaches is essential, wrote authors from the Cha University College of Medicine in Seoul, Korea.

Endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding involves the use of techniques including electrocoagulation and heater probes. Monopolar electrocoagulation, however, can cause a greater degree of tissue injury than bipolar electrocoagulation, which offers less damaging and better focused heat, the article explained.

Hemospray powder (Cook Medical, Bloomington, Indiana) and EndoClot particles (Micro-Tech Europe, Düsseldorf, Germany) are newer agents that create mechanical tamponades, although with limitations, according to the review. The gold probe (Microvasive, Boston, Massachusetts), which combines bipolar electrocoagulation and injection for effective coagulation targeting, is declining in use due to device-related issues. Current first-line treatments include thermal probes and through-the-scope clips with or without adjunctive submucosal epinephrine injection, the article stated. For larger ulcer bleeding, over-the-scope clips are gaining traction.

“In conclusion, endoscopic hemostatic techniques, much like the once-prominent but now less used gold probe, are evolving,” the authors wrote. “While methods such as injection and clipping have been consistently employed in the past, there is a growing scope for newer techniques… Continuous research is necessary to further explore and optimize the application of these hemostatic techniques.”

Reference

Lee AY, Cho JY. Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: a comprehensive review. World J Gastroenterol. 2024;30(15):2087-2090. doi:10.3748/wjg.v30.i15.2087