Bleed management during endoscopic therapy – Part 1 Coagulation forceps

In this 3 part video series I have highlighted some basic tips on bleed management during endoscopic resection.

1. Don’t panic – all bleeding will stop at some point 😊
2. Position the patient so that bleeding point lies opposite to gravity – this allows blood to pool away from bleed point and improves visibility
3. Wash, wash, wash – don’t allow clot to form at the point as this would hamper any attempt to target treat the vessel
4. If available, use soft distal end cap – you can apply mechanical pressure with this and achieve temporary mechanical hemostasis whilst your team get ready with the accessories. This also helps in localisation of exact bleed point more accurately
5. Options to coagulate include
   

• Tip of snare of ESD knife – Soft coagulation mode
• Olympus Coagulation grasper – Soft Coag
• Pentax bipolar forceps – Bipolar setting (In this video I have used pentax bipolar forceps)
• Hot biopsy forceps- cheap and cheerful – Bjorn definitely likes these 😊