Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding

Table 3 Summary of emerging endoscopic modalities for the management of non-variceal upper gastrointestinal bleeding

Modality type	Endoscopic modalities	Mechanism of action
Injection	Endoscopic ultrasound-guided angiotherapy	Controls variceal bleeding by deploying coils and injecting cyanoacrylate glue directly into targeted vessels, and confirming the thrombosis in real time with Doppler
Thermal	Coagulation grasper (Coagrasper)	A combination mechanical and thermal hemostasis device that delivers targeted monopolar coagulation at the precise site of bleeding
	Radiofrequency ablation	High-frequency alternating electrical current delivered to local tissue via radiofrequency electrode, causing thermal coagulative necrosis of the targeted tissue
	Cryotherapy	Induces cell necrosis through cycles of controlled local freezing and thawing of the tissue
	Endoscopic laser coagulation	Instantaneous hemostatic effect due to alterations in structural proteins in the vessel wall causing vessel shrinkage
Topical	Hemospray (TC-325 hemostatic powder)	Non-absorbable mineral powder that forms an adhesive mechanical barrier upon contact with water
	EndoClot (polysaccharide hemostatic powder)	Absorbable modified plant-based polymer that forms a protective gel matrix and concentrates coagulation factors upon contact with water
	Oxidized regenerated cellulose	Absorbable plant-based polymer that provides a matrix for clot formation and enhances platelet activation and adhesion
	Ankaferd Blood Stopper	Standardized mixture of plant extracts that induces formation of an encapsulated protein network which provides focal points for vital erythrocyte aggregation
Mechanical	Over-the-scope clip system	Large caliber clips made of metal alloy nitinol with shape-memory effect that stops bleeding by exerting constant circumferential compression force on the bleeding site
	Endoscopic suturing device	Excludes peptic ulcer from the intra-gastric acidic environment to prevent rebleeding
	Endoscopic band ligation	Complete obliteration of varices by causing mechanical strangulation with rubber bands