| Upper gastrointestinal (GI) bleeding still contributes to significant patient morbidity and mortality. This is despite the fact that the less invasive and effective endoscopic therapy has surpassed surgery as primary management modality. This can be in part attributed to the overall older and sicker patient population frequently taking antiplatelets or anticoagulation drugs. At the same time until recently there have not been any major advances in endoscopic therapy and for years we have been using injection, bipolar or monopolar coagulation and trough the scope clips. Although effective, these therapies carry approximately 15 to 20% rebleeding rate. More recently, there have been some significant advances in endoscopic therapies expanding our choices. These include over the scope clips, suturing devices, and hemostatic gels and powders. Both over the scope clips and suturing try to replicate the concept of surgical "over sewing" of the bleeding target. In addition now we have a variety of hemostatic powders and gels available to us. A key benefit of these devices is that they do not require pinpoint precision of deployment which is mandatory when using coagulation or trough the scope clips. The hemostatic gels and powders can be quickly and easily applied over large area for prompt bleeding control. They can be used in traditional commonly seen settings (PUD, Dieulafoy's lesion, Malory-Wise tears etc.). Furthermore the powders and gels can be used in situation for which traditional endoscopic therapies are not effective such as tumor bleeding. |
