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The management of upper gastrointestinal hemorrhage has improved considerably with advances in endoscopic management techniques and peri-interventional care. Although traditional endoscopic treatments remain irreplaceable to date, new endoscopic techniques are emerging and could rapidly change our practices. For instance, in ulcer disease, OTSC (over-the-scope-clip) has a high success rate as a rescue treatment or as first-line treatment for bleeding ulcers that are difficult to treat. Hemostatic powders are safe, easy to use and allow rapid rescue hemostasis especially for diffuse or difficult to treat lesions. The use of endoscopic suture systems is also under development. In case of refractory bleeding, embolization during arteriography or hemostasis surgery should always be considered. In the management of gastrointestinal bleeding secondary to portal hypertension, elastic ligation of esophageal varices or injection of glue into gastric varices remain the first-line treatments. The use of echo-endoscopy to better guide the injection of biological glue in the treatment of gastric varices is a technique under development. A covered self-expanding metal esophageal stent may be considered as an alternative to the tamponade tube (Blackmore) for refractory bleeding. In this paper, we will discuss the main advances in endoscopic hemostasis techniques for upper gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Résumé: Les tumeurs superficielles œsophagiennes sont des lésions fréquentes, de mauvais pronostic oncologique. Compte tenu des progrès de l'endoscopie diagnostique, ces lésions sont diagnostiquées à des stades de plus en plus précoces, autorisant des résections endoscopiques pour les stades superficiels. L'ESGE a édité en 2015 des critères permettant de considérer comme curative une résection de lésion superficielle œsophagienne. Ces critères diffèrent en fonction du type histologique (adénocarcinome ou carcinome épidermoïde), notamment en raison d'un risque d'invasion ganglionnaire plus élevé en cas de carcinome épidermoïde. À ce jour, peu de données existent concernant la résection endoscopique des cancers superficiels de l'œsophage dans un contexte de cirrhose ou d'hypertension portale, alors que des facteurs de risque confondant existent entre maladies hépatiques et risque de cancer œsophagien. Dans cette mini-revue, nous recensons les quelques études de cas ou séries rétrospectives à effectifs limités, décrivant différentes techniques visant à diminuer le risque hémorragique, telles que la ligature de varices œsophagiennes, la pose d'un shunt intrahépatique par voie transjugulaire, ou la technique du « ligate and let go ». Il existe plus de données concernant la résection endoscopique de lésions gastriques en cas de cirrhose ou d'hypertension portale, ainsi qu'une étude traitant de la résection de tumeurs superficielles toutes localisations confondues (tube digestif haut et bas) chez le patient cirrhotique. Superficial esophageal tumors are common lesions with a poor oncological prognosis. With advances in diagnostic endoscopy, these lesions are being diagnosed at increasingly earlier stages, allowing endoscopic resections for superficial stages. The ESGE published criteria in 2015 to classify as curative a resection of a superficial esophageal lesion. These criteria differ according to the histological type of tumor (adenocarcinoma or squamous cell carcinoma), in particular because of a higher risk of lymph node invasion in the case of squamous cell carcinoma. To date, few data exist concerning endoscopic resection of superficial esophageal cancers in the context of cirrhosis or portal hypertension. There are only case reports or small retrospective series describing different techniques to reduce the risk of bleeding from portal hypertension, such as endoscopic band ligation of esophageal varices, Transjugular intrahepatic portosystemic shunt, or the "ligate and let go" technique. There are more data about endoscopic resection of gastric lesions in cirrhosis or portal hypertension, as well as one study about resection of superficial tumors in all locations (upper and lower gastrointestinal tract) in the cirrhotic patient. [ABSTRACT FROM AUTHOR]