Hôpital Européen Georges-Pompidou, Service d’hépato-gastro-entérologie et endoscopies digestives, 20 rue Leblanc, 75015 Paris
Correspondance : H. Alric
The management of upper gastrointestinal hemorrhage has improved considerably with advances in endoscopic management techniques and peri-interventional care. Although traditional endoscopic treatments remain irreplaceable to date, new endoscopic techniques are emerging and could rapidly change our practices. For instance, in ulcer disease, OTSC (over-the-scope-clip) has a high success rate as a rescue treatment or as first-line treatment for bleeding ulcers that are difficult to treat. Hemostatic powders are safe, easy to use and allow rapid rescue hemostasis especially for diffuse or difficult to treat lesions. The use of endoscopic suture systems is also under development. In case of refractory bleeding, embolization during arteriography or hemostasis surgery should always be considered.
In the management of gastrointestinal bleeding secondary to portal hypertension, elastic ligation of esophageal varices or injection of glue into gastric varices remain the first-line treatments. The use of echo-endoscopy to better guide the injection of biological glue in the treatment of gastric varices is a technique under development. A covered self-expanding metal esophageal stent may be considered as an alternative to the tamponade tube (Blackmore) for refractory bleeding. In this paper, we will discuss the main advances in endoscopic hemostasis techniques for upper gastrointestinal bleeding.