Endoscopic hemostasis is a medical procedure used to control bleeding within the gastrointestinal (GI) tract using an endoscope. An endoscope is a flexible tube with a light and camera that allows doctors to see inside the digestive tract. This procedure is typically performed in cases of gastrointestinal bleeding, which can arise from ulcers, varices, tumors, or other lesions within the esophagus, stomach, intestines, or colon.
Types of Endoscopic Hemostasis Techniques
Injection Therapy: A solution, often saline mixed with adrenaline (epinephrine), is injected into or around the bleeding site to constrict blood vessels and reduce bleeding.
Thermal Coagulation:
- Heater Probe: A probe applies heat to cauterize the bleeding vessel.
- Electrocoagulation: Uses electric current to coagulate the blood and seal the bleeding vessel.
- Argon Plasma Coagulation (APC): Involves the use of ionized argon gas to deliver thermal energy without direct contact, coagulating the bleeding site.
Mechanical Methods:
- Hemoclips or Endoclips: Tiny clips are applied to bleeding blood vessels or ulcer edges to mechanically stop the bleeding.
- Band Ligation: Elastic bands are placed around bleeding varices (commonly in the esophagus or stomach) to cut off blood supply and stop the bleeding.
Topical Agents: Hemostatic agents (e.g., powders, gels, or foams) can be applied to bleeding sites to promote clotting and stop bleeding.
Indications for Endoscopic Hemostasis
- Peptic ulcers
- Esophageal or gastric varices
- Mallory-Weiss tears
- Vascular malformations (angiodysplasias)
- Post-polypectomy bleeding
- Tumor-related bleeding
Procedure
During an endoscopy, the endoscope is inserted through the mouth or anus, depending on the bleeding site, and guided to the source of bleeding. Once identified, one or more of the above techniques are used to control the bleeding. The procedure is minimally invasive and usually performed under sedation.
Benefits
- Minimally invasive alternative to surgery
- Direct visualization of the bleeding site
- Allows for rapid intervention in acute bleeding situations
Risks
While endoscopic hemostasis is generally safe, potential risks include:
- Perforation of the GI tract
- Infection
- Rebleeding
- Reactions to sedation
Endoscopic hemostasis is an essential technique in managing GI bleeding, often saving patients from the need for more invasive surgical interventions.