Endoscopic Hemostasis with Hemoclips, Local Injection and other New Techniques: The Japanese Experience

Summary

The Japanese experience with hemoclips and injection hemostasis was reviewed. Compared with electrocoagulation and laser photocoagulation these techniques are simpler and less expensive. Endoscopic injection of absolute ethanol, as proposed by Asaki, has been widely employed with reports of excellent results. Another injection technique using hypertonic saline with epinephrine is likewise useful, according to its proponent, Hirao. Compared with prototype clips requiring a complex maneuver, hemoclips modified by Hachisu have proven to be easier to handle and more effective. Other newer techniques developed in Japan include the bipolar electrocoagulator and microwave tissue coagulator, both of which have been tested clinically and proven to be effective in selected patients. Reported hemostatic rates of each method need to be interpreted with caution because of a different patient population; the true efficacy of any endoscopic method should be assessed in cases of active arterial bleeding.

Key words:

Bipolar electrocoagulation - Endoscopic ethanol injection - Endoscopic hemostasis - Hemoclips - Hypertonic saline-epinephrine solution - Microwave tissue coagulator