Prophylactic injection of hypertonic saline-epinephrine oral to the papilla for prevention of postsphincterotomy bleeding.
OBJECTIVE
Endoscopic injection of hypertonic saline-epinephrine (HSE) solution oral to the papilla effectively arrests uncontrolled bleeding after endoscopic sphincterotomy (ES). The aim of this study was to evaluate the efficacy of a prophylactic injection of HSE solution oral to the papilla before ES for prevention of post-ES bleeding.


METHODS
Patients scheduled for ES were recruited into this study. Before ES, patients randomly underwent a single submucosal injection of HSE solution (1 mL) 1 to 2-cm oral to the papilla (injection group) or no injection (noninjection group). After ES, patients were prospectively evaluated for occurrence of post-ES complications such as bleeding, perforation, and pancreatitis between the groups.


RESULTS
A total of 120 patients were randomized to the injection group (n=60) or the noninjection group (n=60). The 2 groups were similar with respect to all background variables. Bleeding occurred in 10 patients (8.3%), and the incidence of bleeding was significantly higher in the noninjection group (9/60) than in the injection group (1/60) (P=0.017). Retroperitoneal perforation occurred in 1 patient (injection group) (0.83%). Pancreatitis occurred in 10 patients (8.3%), and the incidence of pancreatitis tended to be higher in the noninjection group (8/60) than in the injection group (2/60) (P=0.095).


CONCLUSIONS
Prophylactic injection of HSE solution oral to the papilla before ES is a simple and inexpensive method, and is effective for prevention of post-ES bleeding.
Matsushita
Mitsunobu
M
Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan. matsumit@hirakata.kmu.ac.jp
Takakuwa
Hiroshi
H
Shimeno
Naoto
N
Uchida
Kazushige
K
Nishio
Akiyoshi
A
Okazaki
Kazuichi
K
D000368:Aged; D014670:Ampulla of Vater; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000627:therapeutic use; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D012462:Saline Solution, Hypertonic; D014662:Vasoconstrictor Agents; D004837:Epinephrine