title: Hypertonic saline-epinephrine local injection therapy for post-endoscopic sphincterotomy bleeding: removal of blood clots using pure ethanol local injection.
abstract: OBJECTIVE
  Bleeding following endoscopic sphincterotomy (EST) is a rare but unavoidable complication of the procedure. We routinely perform local injection of hypertonic saline-epinephrine (HSE) for the treatment of post-EST bleeding. Any blood clot is removed only by irrigation with water after local injection of pure ethanol into the blood clot to cause crusting. We evaluated the usefulness of this treatment method.
  
  
  METHODS
  Subjects were 8 patients (1.2%) with post-EST bleeding requiring hemostatic intervention among 682 patients undergoing EST. After determination of the bleeding point, local injection of HSE was performed. When an adherent blood clot was present, pure ethanol was injected into the blood clot and then irrigation with water was performed to remove the blood clot.
  
  
  RESULTS
  Endoscopic hemostasis was successfully achieved in all the 8 patients (100%). In 4 patients (50%), the adherent blood clots were successfully removed only with pure ethanol local injection into the blood clot followed by irrigation with water. No complications of the hemostatic procedure occurred in any patients.
  
  
  CONCLUSIONS
  This study indicated that hemostasis with HSE local injection can be safe and useful for the treatment of post-EST bleeding, and also that blood clot removal with pure ethanol local injection can be useful.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chuou-ku, Chiba City, Japan. sakai4754@yahoo.co.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakai
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Takao
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Jo
authors.initials: J
authors.lastname: Kurosawa
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Saito
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Tawada
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mikata
authors.forename: Motohisa
authors.initials: M
authors.lastname: Tada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000601:surgery; D001777:Blood Coagulation / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012997:Solvents / Q000008:administration & dosage; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D006490:Hemostatics; D012462:Saline Solution, Hypertonic; D012997:Solvents; D014662:Vasoconstrictor Agents; D000431:Ethanol; D004837:Epinephrine