New and emerging endoscopic haemostasis techniques.

Endoscopic treatment has been accepted as first-line treatment of upper gastrointestinal bleeding, both for variceal as well as for non-variceal haemorrhage. Dual modality treatment including injection therapy with mechanical or thermal haemostatic techniques has shown superior outcome compared with injection monotherapy in non-variceal bleeding. During recent years, new endoscopic devices have been developed and existing endoscopic techniques have been adapted to facilitate primary control of bleeding or achieve haemostasis in refractory haemorrhage. For mechanical haemostasis, larger, rotatable and repositionable clips have been developed; multiple-preloaded clips are also available now. Over the scope clips allow to ligate larger vessels and can close ulcer defects up to 20 mm. Topical, easily applied substances withdraw fluid from the blood and thereby initiate blood clotting. This can be helpful in diffuse oozing bleeding, for example, from tumour or hypertensive gastropathy and has also shown promising results in variceal and arterial bleeding as bridging before definitive treatment is available. Radiofrequency ablation and multiband ligation have emerged as new tools in the endoscopic management of gastric antral vascular ectasia. In acute refractory variceal bleeding, a covered and removable oesophagus stent can provide tamponade and gain time for transport to an interventional endoscopic centre or for radiological intervention such as TIPS.