Mechanical endoscopic methods of haemostasis for bleeding peptic ulcers: areview

Re-bleeding following endoscopic therapy for gastrointestinal bleeding rema ins common probably because injection and thermal methods for treating blee ding are of limited efficacy, especially in the presence of a large bleedin g artery. This chapter reviews mechanical methods of endoscopic haemostasis . The design of clips, which can be delivered through flexible endoscopes, is reviewed with experimental and clinical data of their efficacy. The need for improvements in clip design is stressed. Experimental studies and prel iminary clinical data where available on a variety of other mechanical meth ods of haemostasis are presented, including band ligation, endoloops, sewin g machines, stapling machines, ulcer clamps, corkscrews, balloon tamponade and ferromagnetic tamponade. New, less invasive, surgical methods which mig ht have a place in ulcer haemostasis, including transgastric endoluminal su rgery and flexible endoscopic ulcer excision with wound closure, are discus sed. Mechanical methods offer the best prospect for improvements in securit y of endoscopic haemostasis for bleeding peptic ulcer. More development is required if the results are to improve.