Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers

a prospective randomized trial

S. C. Sydney Chung, Heng Tat Leong, Angus C W Chan, James Y W Lau, Man Yee Yung, Joseph Leung, Arthur K C Li

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background: Rebleeding following epinephrine injection of bleeding peptic ulcers occurs in 10% to 20% of all cases. The addition of a sclerosant has the theoretical advantage of inducing vessel thrombosis and permanent hemostasis. Methods: A prospective randomized controlled trial was conducted to compare injections with epinephrine alone or epinephrine plus absolute alcohol in patients with actively bleeding ulcers at endoscopy. Repeat endoscopy was performed 24 hours later; treatment was repeated in the presence of endoscopic signs of rebleeding. Surgery was performed when arterial bleeding could not be controlled endoscopically, clinical rebleeding with hematemesis or shock occurred, or the transfusion total exceeded 8 units. Results: One hundred sixty patients were enrolled (epinephrine alone, 81; epinephrine and absolute alcohol, 79). They were matched in age, sex, location of ulcers, hemoglobin on admission, shock, and severity of bleeding. Initial hemostasis was comparable: 79 of 81 with epinephrine alone (97.5%) versus 75 of 79 with epinephrine and absolute alcohol (94.9%). No difference was observed between the two with respect to either rebleeding (9 vs 6), need for emergency operation (12 vs 9), transfusion requirement (median, three units vs two units), hospital stay (median, 5 days vs 4 days), mortality (4 vs 7) and ulcer healing at 4 weeks (50 vs 46). Conclusions: The additional injection of absolute alcohol after endoscopic epinephrine injection confers no advantage.

Original languageEnglish (US)
Pages (from-to)591-595
Number of pages5
JournalGastrointestinal Endoscopy
Volume43
Issue number2 PART 2
StatePublished - 1996

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Epinephrine
Ulcer
Alcohols
Hemorrhage
Injections
Ethanol
Hemostasis
Endoscopy
Shock
Sclerosing Solutions
Hematemesis
Peptic Ulcer
Length of Stay
Hemoglobins
Emergencies
Thrombosis
Randomized Controlled Trials
Mortality

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Sydney Chung, S. C., Leong, H. T., Chan, A. C. W., Lau, J. Y. W., Yung, M. Y., Leung, J., & Li, A. K. C. (1996). Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial. Gastrointestinal Endoscopy, 43(2 PART 2), 591-595.

Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers : a prospective randomized trial. / Sydney Chung, S. C.; Leong, Heng Tat; Chan, Angus C W; Lau, James Y W; Yung, Man Yee; Leung, Joseph; Li, Arthur K C.

In: Gastrointestinal Endoscopy, Vol. 43, No. 2 PART 2, 1996, p. 591-595.

Research output: Contribution to journalArticle

Sydney Chung, SC, Leong, HT, Chan, ACW, Lau, JYW, Yung, MY, Leung, J & Li, AKC 1996, 'Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial', Gastrointestinal Endoscopy, vol. 43, no. 2 PART 2, pp. 591-595.
Sydney Chung, S. C. ; Leong, Heng Tat ; Chan, Angus C W ; Lau, James Y W ; Yung, Man Yee ; Leung, Joseph ; Li, Arthur K C. / Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers : a prospective randomized trial. In: Gastrointestinal Endoscopy. 1996 ; Vol. 43, No. 2 PART 2. pp. 591-595.
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abstract = "Background: Rebleeding following epinephrine injection of bleeding peptic ulcers occurs in 10{\%} to 20{\%} of all cases. The addition of a sclerosant has the theoretical advantage of inducing vessel thrombosis and permanent hemostasis. Methods: A prospective randomized controlled trial was conducted to compare injections with epinephrine alone or epinephrine plus absolute alcohol in patients with actively bleeding ulcers at endoscopy. Repeat endoscopy was performed 24 hours later; treatment was repeated in the presence of endoscopic signs of rebleeding. Surgery was performed when arterial bleeding could not be controlled endoscopically, clinical rebleeding with hematemesis or shock occurred, or the transfusion total exceeded 8 units. Results: One hundred sixty patients were enrolled (epinephrine alone, 81; epinephrine and absolute alcohol, 79). They were matched in age, sex, location of ulcers, hemoglobin on admission, shock, and severity of bleeding. Initial hemostasis was comparable: 79 of 81 with epinephrine alone (97.5{\%}) versus 75 of 79 with epinephrine and absolute alcohol (94.9{\%}). No difference was observed between the two with respect to either rebleeding (9 vs 6), need for emergency operation (12 vs 9), transfusion requirement (median, three units vs two units), hospital stay (median, 5 days vs 4 days), mortality (4 vs 7) and ulcer healing at 4 weeks (50 vs 46). Conclusions: The additional injection of absolute alcohol after endoscopic epinephrine injection confers no advantage.",
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AB - Background: Rebleeding following epinephrine injection of bleeding peptic ulcers occurs in 10% to 20% of all cases. The addition of a sclerosant has the theoretical advantage of inducing vessel thrombosis and permanent hemostasis. Methods: A prospective randomized controlled trial was conducted to compare injections with epinephrine alone or epinephrine plus absolute alcohol in patients with actively bleeding ulcers at endoscopy. Repeat endoscopy was performed 24 hours later; treatment was repeated in the presence of endoscopic signs of rebleeding. Surgery was performed when arterial bleeding could not be controlled endoscopically, clinical rebleeding with hematemesis or shock occurred, or the transfusion total exceeded 8 units. Results: One hundred sixty patients were enrolled (epinephrine alone, 81; epinephrine and absolute alcohol, 79). They were matched in age, sex, location of ulcers, hemoglobin on admission, shock, and severity of bleeding. Initial hemostasis was comparable: 79 of 81 with epinephrine alone (97.5%) versus 75 of 79 with epinephrine and absolute alcohol (94.9%). No difference was observed between the two with respect to either rebleeding (9 vs 6), need for emergency operation (12 vs 9), transfusion requirement (median, three units vs two units), hospital stay (median, 5 days vs 4 days), mortality (4 vs 7) and ulcer healing at 4 weeks (50 vs 46). Conclusions: The additional injection of absolute alcohol after endoscopic epinephrine injection confers no advantage.

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