New haemostatic techniques: histoacryl injection, banding/endoloop ligation and haemoclipping

New endoscopic modalities for the haemostasis of upper gastrointestinal bleeding include cyanoacrylate tissue glue injection for oesophageal and gastric varices, ligation using bands and loops for variceal and non-variceal bleeding, and clips for non-variceal bleeding. These new modalities aim to improve primary and secondary haemostasis rates and the safety of endoscopic treatment. Preliminary experience using these modalities has been encouraging, but prospective randomized trials using adequate patient numbers are still needed to validate their efficacy and safety. The choice of treatment will depend on the clinical context and the anatomy of the bleeding lesion. Cyanoacrylate injection, which achieves rapid haemostasis and obliteration of the treated varix, is ideally suited to acute variceal bleeding and the obliteration of large gastric varices. Bands and loops are used in conjunction with a transparent cap attachment for the elective treatment of oesophageal varices. The clip is most effective when a vessel from a non-variceal bleeding source can be identified.