A prospective, randomized trial of large- versus small-volume endoscopic injection of epinephrine for peptic ulcer bleeding.
BACKGROUND
Endoscopic injection of epinephrine in the treatment of bleeding peptic ulcer is considered highly effective, safe, inexpensive, and easy to use. However, bleeding recurs in 6% to 36% of patients. The aim of this study was to determine the optimal dose of epinephrine for endoscopic injection in the treatment of patients with bleeding peptic ulcer.


METHODS
One hundred fifty-six patients with active bleeding or nonbleeding visible vessels were randomized to receive small- (5-10 mL) or large-volume (13-20 mL) injections of a 1:10,000 solution of epinephrine.


RESULTS
The mean volume of epinephrine injected was 16.5 mL (95% CI [15.7, 17.3 mL]) in the large-volume group and 8.0 mL (95% CI [7.5, 8.4 mL]) in the small-volume group. Initial hemostasis was achieved in all patients studied. The number of episodes of recurrent bleeding was smaller in the large-volume group (12/78, 15.4%) compared with the small-volume group (24/78, 30.8%, p = 0.037). The volume of blood transfused after entry into the study, duration of hospital stay, numbers of patients requiring urgent surgery, and mortality rates were not statistically different between the 2 groups.


CONCLUSIONS
Injection of a large volume (>13 mL) of epinephrine can reduce the rate of recurrent bleeding in patients with high-risk peptic ulcer and is superior to injection of lesser volumes of epinephrine when used to achieve sustained hemostasis.
Lin
Hwai-Jeng
HJ
Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Taipei, Taiwan, ROC.
Hsieh
Yu-Hsi
YH
Tseng
Guan-Ying
GY
Perng
Chin-Lin
CL
Chang
Full-Young
FY
Lee
Shou-Dong
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004381:Duodenal Ulcer / Q000150:complications*; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000150:complications*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004837:Epinephrine