What are the new technological advancements in the treatment of gastrointestinal (GI) bleeding?
Janusz Jankowski: This is an excellent question for 3 reasons. Number 1 is the new technology: There is no one new device that is actually changing the landscape of GI bleeding; however, there are small incremental increases by 2 or 3 percentage points in various areas. So if I can pick out 2 devices in particular, there are suction cups which are being used in varices, particularly gastric varices or esophageal varices, in addition to banding or injection of thrombin, which are actually very good at capping off single varices. These are suction devices where the suction cup is left in situ with a vacuum. That is an excellent scenario for specialized center use mainly at the moment, but I think that when the technology improves it will move to the smaller centers.
The second area where there have been some useful devices invented – and it was already made into community practice – is hemospray. In fact, this is a device where inert compounds are sprayed onto the bleeding of ulcers in particular, and it has made a very big difference. The only problem, I would say, with hemospray is you have to keep the tip of the device very dry, which in a retching, bleeding patient with stomach contents full of food, sometimes acid, or indeed blood, is very difficult to do, but when applied it is highly successful.