Endoscopic Therapy - Bleeding

Gastroenterologists are sometimes presented with patients who are bleeding from either oesophageal or gastric varices, ulcers or other pathology (tumours and aberrant arteries amongst them. Bleeding oesophageal varices are usually treated with oesophageal banding, however in those with resistant or ongoing bleeding Sengstaken tubes are sometimes used. In those with well compensated liver disease a TIPS procedure may be considered.

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For patients with bleeding from other cause a range of modalities are available depending on presentation, site and accessibility of the bleeding area. This include injection of adrenaline, which is usually a temporary solution, use of clips (which literally clip onto a bleeding vessel to apply pressure) and other methods of cautery (Argon plasma coagulation- APC and Gold Probe (applying heat to a limited area using current passed through the tip of a catheter). It is generally good practice to apply at least two modalities of therapy in patients who are deemed at high risk of bleeding.