Endoscopic Injection for the Treatment of Bleeding Ulcers: Local Tamponade or Drug Effect?

Abstract

Fifty-two patients with Forrest Ia or Ib bleeding ulcers were randomized to receive endoscopic injection therapy with either 1:10,000 epinephrine in water (Group I) or distilled water (Group II). Twenty-five out of 27 patients in group I, versus 22 out of 25 patients in group II, achieved initial hemostasis after endoscopic injection therapy (p > 0.05). Five patients who did not respond to local injection had bleeding controlled by heater probe thermocoagulation or surgical intervention. Three patients in each group developed rebleeding after initial hemostasis. Four of these patients had bleeding controlled by surgical intervention, while the other two died of underlying diseases. No change in systemic blood pressure, but a significant drop in the pulse rate were noted in both groups after injection therapy. Patients with shock at admission or ulcer size greater than 2 cm had a significantly higher rebleeding rate after initial hemostasis than patients with normal blood pressure and ulcers under 2 cm (p < 0.05). No serious complications were observed after injection therapy, and no significant difference in the amounts of solution required for successful hemostasis was noted between the two groups. We conclude that a local tamponade with distilled water is as effective and safe as diluted epinephrine solution for endoscopic injection therapy.

Endoscopic treatment of upper gastrointestinal bleeding

“…Although its efficacy is demonstrated in studies on peptic ulcers [23], diluted epinephrine can be used for any nonvariceal bleeding lesion. The postulated mechanism of action is primarily by tamponade effect, but epinephrine can also induce vasoconstriction as well as platelet aggregation [24,25]. Aliquots of 0 …”

Is endoscopic injection hemostasis of bleeding gastrointestinal ulcers obsolete in 1995?

“…In accordance with other authors [3] we are carrying out another trial using simple adrenaline 1:10,000 in saline; the initial results do not appear to be different from the reported experience. If this data is confirmed by further trials we will have the unequivocal proof that the hemostatic effect of the periulcer injection is essentially due to the mechanical action of the tissue distension [10], and the ulcer sclerosis or vasal constriction play little part if any in stopping bleeding.…”

Fibrinklebung – Einsatz in der endoskopischen Akutbehandlung der Ulkusblutung

“…2) durch das interstitiell injizierte Volumen des Injektionstherapeutikums [14][15][16]. Unklar ist welche Bedeutung die zusätzlichen Effekte der eingesetzten Injektionstherapeutika (z.…”