© Georg Thieme Verlag KG Stuttgart · New York
Gastrointestinal bleeding: capsules, balloons, and spirals!
11 January 2010 (online)
Gastrointestinal bleeding continues to be a challenging emergency for gastroenterologists despite the advances in modern medicine. Treatment of bleeding from gastric varices is a life-threatening emergency, and the lack of an ideal and universally acceptable method for arresting the bleed further complicates the situation. Over the years, small-bowel endoscopy has evolved from push enteroscopy to capsule endoscopy, balloon enteroscopy, and more recently to spiral enteroscopy. In addition, the concept and preliminary results of a therapeutic capsule endoscope are fascinating and it seems to be a technology of the future. Over time, the management of patients with bleeding peptic ulcers has radically changed from the administration of “tonnes” of antacids and emergency surgery to aggressive antisecretory therapy and various endoscopic injection, thermal, and mechanical hemostatic methods that reduce the need for emergency surgery. Now attempts are being made to identify the cost-effective dose of proton pump inhibitors (PPIs) that can be used following endoscopic therapy of bleeding peptic ulcers. Here, we review five studies published during the past year that reflect the state-of-the-art on the topic of gastrointestinal bleeding.