Nonthermal Methods for Control of Gastrointestinal Bleeding: Inject, Clip, Sprays

Abstract

Gastrointestinal bleeding (GIB) is a common cause of hospitalization that requires appropriate diagnosis and treatment. The first step in management of any bleeding patient is early initiation of appropriate resuscitation measures. How and when to endoscopically approach a patient with GIB depends on the anticipated bleeding source and the hemodynamics of the patient. Modern endoscopists possess a variety of nonthermal treatment modalities that can help achieve hemostasis at a site of gastrointestinal bleeding, including submucosal injection, hemostatic clip placement, rubber band ligation, and hemostatic sprays. The indications and techniques for use of these methods will be discussed in this chapter. Less common and specialized bleeding treatment modalities include over-the-scope clip placement, intravascular coil/glue injection, and endoscopic suturing. An appropriate understanding and judicious use of these hemostatic devices improves outcomes for patients presenting with gastrointestinal bleeding.