Can endoscopic injection of epinephrine prevent surgery in gastroduodenal ulcer bleeding? An analysis of 107 cases.
BACKGROUND
Gastroduodenal ulcers are still a common cause of severe upper gastrointestinal bleeding. Endoscopy has gained popularity worldwide over conventional open surgery for the treatment of upper gastrointestinal bleeding. This study aims to assess the efficacy of endoscopic injection of epinephrine in the treatment of gastroduodenal ulcer bleeding.


METHODS
This study was conducted between March 2000 and March 2003. We analyzed 107 consecutive patients admitted to our department of trauma and emergency surgery with upper gastrointestinal bleeding. Endoscopy was performed on all 107 patients and bleeding ulcers were treated with injection of diluted epinephrine.


RESULTS
Recurrent bleeding was seen in 21 patients (19.6%), all of whom underwent a second endoscopy. Four patients (3.7%) required a third endoscopy session and nine patients (8.5%) needed surgery after endoscopy failed. There were two mortalities (1.9%). The nine patients who required surgery and the two patients who died were all in the Forrest Ia and Ib groups of acute UGI hemorrhage.


CONCLUSIONS
Endoscopic injection therapy with epinephrine reduces operation rates and can be used safely in adequate hemostasis of gastroduodenal ulcers.
Ertekin
Cemalettin
C
Department of Trauma and Emergency Surgery, University of Istanbul, Istanbul Medical Faculty, Istanbul, Turkey. cemalettin@ertekin.info
Yanar
Hakan
H
Taviloglu
Korhan
K
Guloglu
Recep
R
Alimoglu
Orhan
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications* / Q000601:surgery; D012008:Recurrence; D019233:Retreatment; D015996:Survival Rate; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D014662:Vasoconstrictor Agents; D004837:Epinephrine