Sewing machine and experimental devices for nonvariceal hemorrhage

Abstract

Current endoscopic methods for hemostasis in the gastrointestinal tract, such as injection, thermal probes, and lasers, are relatively ineffective if a large artery is eroded by an ulcerating process. This article will review some experimental endoscopic devices that have been developed to treat bleeding from bleeding peptic ulcer and other sources of gastrointestinal bleeding. Progress with methods for flexible endoscopic suturing using sewing machines is reviewed and methods for tying knots and cutting thread are described. Other mechanical methods of endoscopic ulcer hemostasis are reviewed, including stapling, the application of clips, elastic bands, ulcer clamps, endoloops, screws, balloon, and ferromagnetic tamponade. Some less commonly used thermal methods are also described, including microwave and argon plasma coagulation, bipolar forceps, sapphire, and polytetrafluoroethylene-tipped contact laser probes. The advent of new endoluminal surgical methods such as transgastric surgical techniques using rigid laparoscopic instruments and flexible endoscopic ulcer excision with wound closure are described.