Optimal injection volume of epinephrine for endoscopic prevention of recurrent peptic ulcer bleeding.
BACKGROUND
Although the initial rate of hemostasis achieved by endoscopic epinephrine injection for peptic ulcer bleeding is high, bleeding recurs in 14.6% to 35.5% of patients. The aim of this study was to compare rates of recurrent bleeding after endoscopic injection of two different volumes of epinephrine in patients with peptic ulcer bleeding.


METHODS
A total of 72 patients with peptic ulcer with active bleeding or a non-bleeding visible vessel were randomly assigned to 15 to 25 mL or 35 to 45 mL injections of a 1:10,000 solution of epinephrine.


RESULTS
The two groups were similar with respect to all background variables. The mean volume of epinephrine injected was 19.4 mL: 95% CI [18.7, 20.1] in the 15 to 25 mL group and 41.1 mL: 95% CI [40.0, 42.2] in the 35 to 45 mL group. Initial hemostasis was achieved in 35 of 36 patients (97.2%) in the 15 to 25 mL group and in all 36 patients in the 35 to 45 mL group. The 35 to 45 mL volume was significantly more effective in preventing recurrent bleeding than the 15 to 25 mL volume (0% vs. 17.1%; p < 0.05). For ulcers in the gastric body, the 35 to 45 mL volume was significantly more effective in preventing recurrent bleeding than the 15 to 25 mL volume (0% vs. 31.6%; p = 0.003). For ulcers in other locations, including the gastric antrum and the duodenum, there were no significant differences in the rate of recurrent bleeding between the two groups.


CONCLUSIONS
Injection of 35 to 45 mL of a 1:10,000 solution of epinephrine is more effective than injection of 15 to 25 mL of the same solution for prevention of recurrent bleeding from ulcers in the body of the stomach.
Park
Chang-Hwan
CH
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-ku, Gwangju 501-757, Korea.
Lee
Soo-Jung
SJ
Park
Jeong-Ho
JH
Park
Jae-Hong
JH
Lee
Wan-Sik
WS
Joo
Young-Eun
YE
Kim
Hyun-Soo
HS
Choi
Sung-Kyu
SK
Rew
Jong-Sun
JS
Kim
Sei-Jong
SJ
D004305:Dose-Response Relationship, Drug; D004381:Duodenal Ulcer / Q000150:complications; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005773:Gastroscopy; D006489:Hemostatic Techniques; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D019233:Retreatment; D055502:Secondary Prevention; D016037:Single-Blind Method; D013276:Stomach Ulcer / Q000150:complications; D015996:Survival Rate
D004837:Epinephrine