Upper Digestive Hemorrhage

Upper gastrointestinal bleeding can range from mild to severe, getting patients’ lives at risk. There are different causes of upper gastrointestinal bleeding, since any injury can bleed at any time.

What are the symptoms of upper gastrointestinal bleeding?

Generally, the clinic of the patients determines whether a digestive bleeding is high or low, however, an endoscopy is required to identify the real origin of the bleeding and not only this, but also to perform the most appropriate endoscopic treatment.

Endoscopic treatment of upper gastrointestinal bleeding is based on using alone or in combination, o 3 types of hemostatic techniques:

1. a) Injection methods based on the injection of substances such as adrenaline, polidocanol, absolute alcohol or cyanoacrylate to generate hemostasis due to thrombosis of the bleeding vessel.

1. b) thermal methods consisting in achieving hemostasis by applying a heat source: thermal probe, multipolar or monopolar electrocoagulation, argon plasma gas or Yag laser.

1. c) mechanical techniques such as elastic bands and clips, which facilitate

           hemostasis by mechanical compression.

Below we describe some causes of bleeding and the endoscopic treatment indicated, among others:

Rubber Band Ligation:

this procedure uses rubber bands similar to those used for dental braces. These fit into a “barrel” that is attached to the tip of the endoscope and inserted into the esophagus: the bleeding varix is ​​aspirated into the barrel and the band that strangles the varix is ​​released and stops the bleeding.

Endoscopic sclerotherapy:

In this procedure, a needle is inserted through the endoscope and different substances are applied to stop digestive bleeding. Generally, the application of this procedure alone is not 100% safe and it is necessary to apply another technique such as local heat or Argon Plasma.

Argon Plasma Coagulation:

an electrical current surrounded by an Argon gas is applied through the endoscope and using a probe, causing a “desiccation” of the tissues and immediate coagulation of the blood vessels.

Application of Hemoclips:

The clips are metallic steel devices, which act and produce hemostasis through direct vascular compression or the surrounding tissue without causing inflammatory reaction or tissue damage. This characteristic differentiates them from injection and coagulation techniques. The application of hemostatic clips is performed using an endoscope and is a safe procedure without excessive technical complexity.

Ablation of Gastric Varices with Cyanoacrylate:

Acute bleeding due to rupture of gastric varices is the most serious consequence of portal hypertension or increased pressure in the main veins of the liver, it is associated with high mortality rates. The most promising treatment for this condition is considered endoscopic ablation that allows direct visualization and treatment of bleeding varices with a substance called cyanoacrylate. This is an adhesive that causes blood clots to form and stops the bleeding immediately. It is injected into the varicose vein through the endoscope and using a special needle. The procedure is carried out under sedation and is generally outpatient, which means that the patient can be sent home after a couple of hours.

Gastric Varix 

Variceal Injection

Treated Gastric Varix