Stopping a bleed from the inside
When the gut bleeds, the fastest and least invasive way to stop it is usually through an endoscope, reaching the bleeding point directly and treating it on the spot. Different bleeds need different tools. For the oesophageal varices of cirrhosis, band ligation is the mainstay. For two other common problems, bleeding gastric varices and bleeding ulcers or vessels, the answer is often cyanoacrylate glue or hemoclips.
Cyanoacrylate glue for gastric varices
Gastric varices behave differently from oesophageal ones: they are often larger, fed by high-flow vessels, and band ligation frequently is not the right tool. Here the treatment of choice is injection of a tissue adhesive, cyanoacrylate glue, a medical “superglue.” Injected directly into the varix through a fine needle passed down the endoscope, it sets almost instantly on contact with blood, plugging the varix from within and stopping the bleed. Over the following weeks the glue cast is gradually extruded as the varix shrinks. Glue injection is recognised as a first-line endoscopic treatment for bleeding gastric varices.
It is a technically demanding procedure, the glue sets in seconds, so timing and technique matter, and it carries a small risk that a fragment of glue travels in the bloodstream to the lungs or elsewhere (embolisation). Done by an experienced endoscopist, it is highly effective at controlling what can be a life-threatening bleed. Increasingly, glue is combined with coils under EUS guidance for even more precise, secure obliteration of difficult gastric varices.
Hemoclips for ulcers and other bleeding
For bleeding that is not from a varix, a peptic ulcer with a visible vessel, a tear, a polypectomy site, or a fragile vessel, a hemoclip is often the ideal tool. A hemoclip is a tiny metal clamp, deployed through the endoscope, that pinches the bleeding vessel or closes the defect mechanically, much like a surgical stitch, but placed endoscopically and without any cutting. Clips work at once, add no thermal injury to the tissue, and are frequently combined with an adrenaline injection or a heat probe for the most reliable control. The clips are harmless and eventually fall off on their own, passing out naturally.
Where these fit alongside band ligation
Think of the endoscopic haemostasis toolkit as matched to the target: band ligation for oesophageal varices, cyanoacrylate glue (with or without coils) for gastric varices, and hemoclips (often with adrenaline or thermal therapy) for ulcers and non-variceal bleeds.
Dr Kalal’s role
Therapeutic endoscopy for GI bleeding is core to Dr Kalal’s practice. He performs endoscopic haemostasis, including cyanoacrylate glue injection for gastric varices and clip placement for non-variceal bleeding, and, for the most complex gastric varices, integrates EUS-guided glue-and-coil techniques and coordinates with interventional radiology when a procedure such as BRTO or TIPS is the better long-term answer.