Prolonged evaluation of epinephrine and normal saline solution injections in an acute ulcer model with a single bleeding artery.
BACKGROUND
Animal studies of epinephrine or normal saline solution injection for bleeding ulcers do not consistently demonstrate local tamponade effect.


METHODS
We studied the change of bleeding rates of 28 acute gastric ulcers with a single bleeding artery in 10 dogs. Four injections of 1 mL epinephrine 1:10000 at 1 mm from the spurting artery (n = 7) were compared to four injections of normal saline solution 1 to 5 mL (n = 12) and to four dry needle sticks (n = 9). Bleeding rates were measured at initial arterial incision and at minutes 1, 5, 10, 15, 20, 25, and 30 after treatment.


RESULTS
Reductions in early blood loss to 24.3% +/- .05 of baseline occurred with saline solution, to 17.7% +/- .03 with epinephrine, and to 66.0% +/- 1.8 in controls (p < .05 for epinephrine and saline solution vs control). A tendency for saline solution injected ulcers to resume bleeding was identified, with late blood loss increasing to 26.9% +/- .05 of baseline, (saline solution vs control) compared to 7.7% +/- .02 in epinephrine injected ulcers (p < .05 vs control).


CONCLUSIONS
The early acute hemostatic effect of injection therapy depends on local tamponade. The prolonged hemostatic effect is a combination of tamponade and vasoconstriction, with advantage of epinephrine over saline solution.
Pinkas
H
H
College of Medicine, Department of Medicine, University of South Florida, Tampa, USA.
McAllister
E
E
Norman
J
J
Robinson
B
B
Brady
P G
PG
Dawson
P J
PJ
D000818:Animals; D004285:Dogs; D004837:Epinephrine / Q000008:administration & dosage*; D016558:Hemostasis, Endoscopic; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012965:Sodium Chloride / Q000008:administration & dosage*; D013276:Stomach Ulcer / Q000150:complications*; D013997:Time Factors
D012965:Sodium Chloride; D004837:Epinephrine