title: A prospective, randomized trial of large- versus small-volume endoscopic injection of epinephrine for peptic ulcer bleeding.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Medicine, VGH-TAIPEI, Taipei, Taiwan, ROC.
authors.forename: Hwai-Jeng
authors.initials: HJ
authors.lastname: Lin
authors.forename: Yu-Hsi
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Guan-Ying
authors.initials: GY
authors.lastname: Tseng
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Perng
authors.forename: Full-Young
authors.initials: FY
authors.lastname: Chang
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: 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*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine