Endoscopic hemostasis: current hemostatic devices and their clinical outcomes

Non-variceal upper gastrointestinal bleeding remains a major clinical challenge in aging societies, driven by increasing life expectancy and the widespread use of antithrombotic and ulcerogenic medications. Although conventional endoscopic hemostatic techniques-including injection therapy, thermal modalities, and mechanical clipping-remain the cornerstone of management, rebleeding continues to occur in a substantial proportion of patients, particularly in large, fibrotic, or difficult-to-access lesions. In recent years, novel therapeutic devices such as over-the-scope clips and topical hemostatic agents have expanded the endoscopic armamentarium and have demonstrated promising clinical outcomes, especially in high-risk bleeding scenarios and tumor-related hemorrhage. In parallel, adjunctive diagnostic technologies, including red dichromatic imaging and Doppler endoscopic probes, have emerged to improve the localization of bleeding sources and refine rebleeding risk stratification by assessing residual submucosal blood flow. This review summarizes currently available endoscopic hemostatic devices and adjunctive diagnostic tools, highlighting their mechanisms of action, clinical efficacy, and limitations. An integrated approach combining advanced therapeutic modalities with complementary diagnostic techniques may facilitate individualized endoscopic management and improve hemostatic success while reducing rebleeding in patients with non-variceal upper gastrointestinal bleeding.