Endoscopic haemostasis of the upper gastrointestinal tract

The realm of endoscopy has gone from that of diagnosis to that of diagnosis and therapy. Therapeutic endoscopy is a rapidly advancing frontier in the field of gastroenterology. Its use in securing haemostasis has recently flourished. Considerable progress has been made. Various experimental techniques have been tried and found lacking, while others, such as laser photocoagulation, electrohydrocoagulation and endoscopic sclerotherapy, are proving to be very useful. The mortality for upper gastrointestinal bleeding has remained high for decades, despite recent advances in medicine. This may be related to the shift in the population toward the older age group. Recent advances in endoscopic haemostasis seem to be showing promise in improving survival rates. This is a result of improved recognition of risk factors, including the stigmata of recent haemorrhage, of early surgical intervention in the elderly, and of the ability to reliably secure haemostasis endoscopically. This chapter gives an account of the various techniques of endoscopic haemostasis and explains the numerous controversies through the discussion of selected experimental and clinical trials.