Techniques and outcomes review of the endoscopic management of gastrointestinal bleeding

INTRODUCTION: Gastrointestinal (GI) bleeding is a frequent and potentially life-threatening emergency that imposes a substantial healthcare burden worldwide. Over the past three decades, advances in endoscopic technology and technique have transformed management, shifting the emphasis from predominantly diagnostic procedures to targeted, minimally invasive therapeutic interventions across the upper, lower, and small bowel. AREAS COVERED: This review synthesizes current evidence and guideline-based strategies for endoscopic management of GI bleeding, with a structured focus on non-variceal and variceal upper GI bleeding, lower GI bleeding, and small bowel bleeding. Key therapeutic modalities include combination therapies for peptic ulcer bleeding, band ligation for esophageal and selected gastric varices, argon plasma coagulation (APC) for vascular malformations and tumor bleeding, and emerging approaches such as over-the-scope clips (OTSC), hemostatic powders, radiofrequency ablation (RFA), and self-expandable metal stents (SEMS). Capsule endoscopy and device-assisted enteroscopy have markedly improved the evaluation and treatment of small bowel bleeding. We also review risk stratification scores, transfusion strategies, and timing of endoscopy, all of which are crucial to optimizing outcomes. EXPERT OPINION: Successful management of GI bleeding demands a personalized approach integrating patient-specific factors, bleeding etiology, and local expertise. Emerging technologies, particularly artificial intelligence (AI)-assisted imaging and novel hemostatic devices, are poised to refine diagnosis, risk prediction, and therapy selection. Nonetheless, clinical judgment, multidisciplinary collaboration, rigorous training, and thoughtful resource allocation remain paramount to ensure safe, effective, and sustainable care in this rapidly evolving field.