title: Treating delayed endoscopic sphincterotomy-induced bleeding: epinephrine injection with or without thermotherapy.
abstract: OBJECTIVE
  To compare the hemostatic efficacy between epinephrine injection alone and epinephrine injection combined with thermotherapy for delayed post-endoscopic sphincterotomy (ES) bleeding.
  
  
  METHODS
  Cases with delayed post-ES bleeding undergoing epinephrine injection alone (epinephrine injection group, n = 26) or epinephrine combined with thermotherapy (combination therapy group, n = 33) in our institution between 1999 and 2007 were retrospectively investigated. The main outcome measurements were: initial endoscopic hemostasis, re-bleeding, complications, requirement of angiographic embolization or surgery, requirement for blood transfusion, and mortality.
  
  
  RESULTS
  The initial hemostatic efficacy was 96.2% for epinephrine injection alone and 100% for combination therapy (P = 0.44). There were four patients with re-bleeding in each group (16.0% vs 12.1%, P = 0.72). There was only one complication of pancreatitis from the combination therapy group. Three patients (11.5%) in the epinephrine injection group and one patient (3%) in the combination therapy group required angiographic embolization or surgery (P = 0.31). The total number of blood transfusions was not significantly different between the two groups (3.5 +/- 4.6 U vs 3.5 +/- 4.5 U, P = 0.94). There was no bleeding-related death in either group.
  
  
  CONCLUSIONS
  Epinephrine injection alone is as effective as epinephrine injection combined with thermotherapy for the management of delayed post-ES bleeding.
authors.affiliation: Department of Hepato-Gastroenterology, Division of Therapeutic Endoscopy, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taipei, Taiwan, ROC.
authors.forename: Yung-Kuan
authors.initials: YK
authors.lastname: Tsou
authors.forename: Cheng-Hui
authors.initials: CH
authors.lastname: Lin
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Liu
authors.forename: Jui-Hsiang
authors.initials: JH
authors.lastname: Tang
authors.forename: Kai-Feng
authors.initials: KF
authors.lastname: Sung
authors.forename: Chi-Liang
authors.initials: CL
authors.lastname: Cheng
authors.forename: Ching-Song
authors.initials: CS
authors.lastname: Lee
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D006470:Hemorrhage; D006487:Hemostasis; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000494:pharmacology
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine