New technology is making upper GI procedures safer and more efficient. From a spray-on powder that controls bleeds and less invasive weight-loss surgery to treating swallowing disorders and resecting larger and deeper lesions, here are some of the latest tools and techniques you and your GI docs should know about.

1. Stop bleeding with a spray-on coagulating powder

Upper gastrointestinal bleeding (UGIB), caused by everything from peptic ulcers to gastritis, is a common problem in upper GI procedures. Apart from indicating a larger medical issue, bleeding can also obscure visualization during an endoscopy, leaving your GI doctors open to the risk of missing lesions during the procedure. GI docs usually try to stop bleeding with cauterization or by applying a clip to the problem ulcer. But this doesn't always work. A 2010 study found that initial hemostasis was achieved in 85% to 95% of cases when doctors used combined endoscopic therapy, including injecting epinephrine, or by thermal and mechanical means. But that still leaves about a 10% risk of rebleeding.

Now doctors can spray the area of the bleeding with a coagulating powder that only attaches to areas of bleeding and absorbs water molecules, essentially helping to form clots at the site of the bleeding, says Jon Hlivko, MD, assistant professor of internal medicine at Northeast Ohio Medical University in Rootstown, Ohio, who calls the endoscopically-applied powder "immediate hemostasis."

"It creates a matrix when it sprays on the area of bleeding," says Seth Gross, MD, chief of gastroenterology at Tisch Hospital in New York, N.Y.

A doctor administers the powder in short bursts, using the pump that's attached to a thin catheter that's fed through the endoscope's channel.

"Sometimes the bleeding comes so fast, you can't even see where it's coming from," says Dr. Hlivko, adding that the hemostatic powder can be invaluable when it's difficult to clip closed a bleeding ulcer on the walls of the curved areas in the stomach.

The spray isn't yet available in the United States — although products like Hemospray by Cook Medical are sold almost everywhere else — but that could change soon, says Dr. Gross. The FDA has recently approved spray coagulation powders, including Hemoblast Bellows by Biom'Up, for use during non-endoscopic procedures.

2. Less-invasive weight loss

Patients who are looking to undergo serious weight-loss procedures have traditionally turned to bariatric surgery, but its nature as an invasive procedure can come with its own host of negative side effects. A retrospective study that examined almost 700 gastric bypass patients between the summer of 2013 and fall of 2014 found that 24% suffered post-op complications that required hospital readmission, with many patients needing a cholecystectomy.

That's where endoscopy steps in. Endoscopy-assisted procedures and devices offer less invasive methods of weight loss therapy, and they're becoming more popular. "Endoscopic weight loss options will likely continue to grow," says Dr. Hlivko, adding that doctors are seeking alternatives to traditional weight-loss surgery. A few examples:

• Single gastric balloon. The gastric balloon is an increasingly popular endoscopic weight-loss device that bypasses the need for surgery. The balloon is inserted via endoscope and inflated in the patient's stomach. "The entire apparatus is pure upper GI," says Subha Sundararajan, MD, director of interventional endoscopy at Riverview Medical Center in Red Bank, N.J.

  The procedure is relatively simple. You attach the deflated balloon to an endoscope and place it in the stomach. You then inflate it with 600 mls of saline solution and detach the balloon from the scope, says Dr. Gross. Often doctors will also inject the balloon with 10 ml of methylene blue, which changes the color of urine, thus alerting the patient to a popped balloon, says Dr. Hlivko.

  The device sits inside the fundus region of the patient's stomach for 6 months, keeping the patient from overeating by taking up space inside the stomach. Once the 6 months are up, the doctor will conduct another endoscopy, puncture the balloon and use suction to remove the saline solution from inside, says Dr. Sundararajan, adding that patients typically lose 25 to 45 pounds in the 6 months that they have the balloon. ?

• Double gastric balloon. While the single gastric balloon has been increasing in popularity over the past few years, so has another, similar device that uses 2 balloons. The doctor inserts and inflates 2 balloons that are attached to each other, and then fills them with saline.

  "It looks like a dumbbell," says Dr. Hlivko, adding that the 2-balloon device has an added benefit: If one of the balloons pops, it will still remain in the stomach, anchored there by its other half and reducing the likelihood that you'll have to surgically remove it from the small intestine.

• Endoscopic sleeve gastroplasty. Along with adopting new devices for endoscopy-assisted weight loss, doctors are also looking at ways to use older devices in newer procedures. Take endoscopic sleeve gastroplasty, for example. The procedure mimics the already popular sleeve gastrectomy, in which most of the stomach is removed surgically, says Dr. Gross. But in the case of gastroplasty, the area of the stomach that would be removed is instead sewn together, effectively reducing the volume of the stomach by 70%, according to researchers at Johns Hopkins University. The result is a far less invasive outpatient procedure that leaves no visible scars.

Though it's a relatively new procedure, endoscopic sleeve gastroplasty uses an endosuturing scope add-on, which many GI doctors frequently use to close large ulcers or lesions that can't be fixed with a clip.

Endoscopic submucosal dissection lets GI docs resect larger and deeper gastrointestinal lesions.

The endosuturing device has 2 parts: a needle and a holder. In gastroplasty, the holder grips the walls of the stomach while the needle sutures the stomach tissue walls together from the antrum to the fundus. The doctor leaves only a small tube of gastric lumen remaining to connect the esophagus to the pyloric sphincter.

"The whole idea is to do the least invasive way of managing a condition," says Dalbir Sandhu, MD, chief of endoscopy at MetroHealth Medical Center in Cleveland, Ohio.

Researchers say the process, which is completed entirely endoscopically, takes anywhere from 90 minutes to 2 hours and can be done in an outpatient procedure, with patients fully recovered in 1 to 3 days. Like other endoscopic weight-loss procedures, gastroplasty reduces weight loss by reducing the available space in the stomach. "It creates a lower ability to accommodate food," says Dr. Gross. Studies showed that patients reported 30% excess weight loss after the procedure.

3. Easily remove dangerous tissue

Gastroenterologists have often used endoscopic mucosal resection (EMR) to tackle and remove gastrointestinal lesions and to manage early gastric cancer. But a new procedure has been increasing in popularity over the past few years, endoscopic submucosal dissection (ESD), which can help resect larger and deeper lesions. ESD removes flat, raised polyps and mucosal neoplastic lesions in the stomach, which can't be taken out by the average biopsy forceps, says Dr. Gross. ESD also helps resect small bumps that are not on the surface of the mucosa, says Dr. Sundararajan. The doctor marks the perimeter of the lesion with a dye before injecting a lifting fluid underneath the lesion, into the submucosa to elevate it, says Dr. Gross. You can use several different substances for the lifting fluid, but many doctors use 0.4% hydroxypropyl methylcellulose because it's relatively inexpensive and effective, according to a 2014 ESD analysis in the Gastrointestinal Endoscopy Journal.

After injecting the lifting fluid, the doctor will use a special electrosurgery knife — the knives can measure anywhere from 2 mm to 4.5 mm in length — to cut around the circumference of the lesion before "tunneling under," cutting into the submucosa and resecting the lesion, says Dr. Gross. "You have to lift it up and almost unearth it in a sense," says Dr. Sundararajan. The procedure helps your doctor resect a larger lesion — one that otherwise might need to be taken out via surgery.

As ESD grows in popularity, researchers have developed new types of retraction devices to help with the removal of lesions and polyps during ESD and EMR procedures. The devices, which fit over an endoscope, have expandable cages to stretch the lumen of the esophagus open to stabilize the scope and increase your doctor's ability to see potential lesions during an endoscopy. They also have forceps that can grasp, retract and manipulate tissue for better traction during an ESD procedure, says Dr. Gross, who adds that the technology isn't readily available yet.

4. Solve swallowing disorders

Peroral endoscopic myotomy (POEM), another relatively new and increasingly popular procedure, helps treat such swallowing disorders as achalasia, says Dr. Gross. The procedure works similarly to ESD in many ways — namely that you cut into and tunnel through the submucosal layer — but it's focused on an area in the mid to lower esophagus.

The doctor makes an incision into the wall of the mid esophagus and moves the scope into that incision, traveling through the submucosa until he's about 2 to 3 cm into the proximal section of the stomach. Once there, he performs a myotomy, cutting the tense muscle fibers that are causing achalasia.

"With POEM, you're cutting down deeper into the muscle to release tension," says Dr. Sundararajan. "The only option [before POEM] was surgery from the outside in." POEM, introduced in Japan in 2008, hasn't been practiced in the United States until recently. OSM