Endoscopic treatment for high-risk bleeding peptic ulcers: a comparison of epinephrine alone with epinephrine plus ethanolamine.
BACKGROUND
Among the various methods of combined endoscopic therapy for high-risk bleeding peptic ulcers the use of adrenaline followed by injection of ethanolamine is minimally demanding in terms of the endoscopic skills and instrumentation but has not been adequately studied. The aim of the present study is to determine whether the injection of ethanolamine in combination with epinephrine compared to injection of epinephrine alone reduces rebleeding rates, need for surgery and overall mortality of patients with bleeding ulcers.


METHODS
Patients with ulcers and endoscopic features indicative of a high risk for spontaneous recurrent bleeding were included. High risk was defined by the Forrest classification. Patients were assigned to injection of epinephrine alone (n = 284) or epinephrine plus ethanolamine (n = 131).


RESULTS
Initial hemostasis was achieved in 96% of patients in both groups. We detected significant difference in rates of recurrent bleeding, 16.4% vs. 8.7%, for epinephrine and epinephrine plus ethanolamine respectively (P<0.05). When patients were stratified according to Forrest criteria, no significant difference could be found, although there was a trend towards less recurrent bleeding in the case of dual injection therapy in all patient subgroups. There was no significant difference in the proportions of patients who required surgery, 7.7% vs. 7.6% respectively. Mortality was equal (3.2 vs. 3.1%) in the two groups. No major complications from endoscopic treatment were observed in either group.


CONCLUSIONS
Adding ethanolamine to epinephrine for injection treatment of bleeding peptic ulcers decreases bleeding recurrence rates and represents a safe endoscopic treatment for high-risk bleeding ulcers.
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Anastasios
A
Konstantinidis
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Vassilis
V
Valatas
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Vassilis
V
Ntelis
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Vassilis
V
Balatsos
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Ioannis
I
Karoumpalis
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Athanasios
A
Hatzinikoloaou
2 Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital, Athens, Greece (Spilios Manolakopoulos, Athanasios Archimandritis).
Spilios
S
Manolakopoulos
1 Department of Propedeutic Medicine, Laikon General Hospital, Athens, Greece (Irene Vafiadis).
Irene
I
Vafiadis
2 Department of Internal Medicine, Athens University Medical School, Hippokration General Hospital, Athens, Greece (Spilios Manolakopoulos, Athanasios Archimandritis).
Athanasios
A
Archimandritis
Department of Gastroenterology, "G. Gennimatas" General Hospital, Athens, Greece (Anastasios Konstantinidis, Vassilis Valatas, Vassilis Ntelis, Vassilis Balatsos, Ioannis Karoumpalis, Athanasios Hatzinikolaou, Nikolaos Skandalis).
Nikolaos
N
Skandalis
bleeding peptic ulcer; endoscopic injection; epinephrine; ethanolamine