Endoscopic Treatments for Gastrointestinal Bleeding: a Story of Cleverness and Success

In the early 1970 s, various endoscopists in Germany and Japan began utilizing various through-the-scope utensils to treat gastrointestinal bleeding (GIB), including clips and electrocoagulation devices. In this editorial, we evaluate a landmark paper published in 1976 by Dr. Nib Soehendra, who had designed a new needle inserted through a simple polyvinyl chloride (PVC) sheath to treat bleeding gastric ulcers. The paper describes two patients with bleeding gastric ulcers [1]. The first patient was found to have a bleeding ulcer at the level of the cardia. The second patient was a patient who had undergone a Whipple’s operation and presented with pulsating bleeding from an anastomotic ulcer. In the latter patient, therapy by electrocoagulation failed; in the first patient, electrocoagulation was deemed too dangerous because of the shape and location of the ulcer. Therefore, Soehendra proceeded to inject the ulcers with Ethoxysclerol using the new needle inside the PVC sheath, which led to rapid and successful hemostasis in both patients. He named the technique “transendoscopic submucous infiltration.”