Efficacy of ethanol and hypertonic saline-epinephrine injection therapy for peptic ulcer bleeding

Ahn, Ji Yong; Kim, Jae Gyu; Kim, Jeong Wook; Kim, Sang Jung; Han, Sang Pyo; Kim, Hyung Joon; Do, Jae Hyuk; Chang, Sae Kyung; Park, Sill Moo

Abstract

BACKGROUND: One of simple, inexpensive, readily available treatments for treating peptic ulcer bleeding is injection of the lesion with a sclerosing substance such as ethanol and hypertonic saline-epinephrine. The aim of this study was to compare the hemostatic efficacy of endoscopic injection therapy with ethanol, hypertonic saline-epinephrine, and ethanol plus hypertonic saline- epinephrine.
METHODS
173 patients with active bleeding or nonbleeding visible vessels were classified into three groups based on treatment modality as follows; ethanol injection group (n=67), hypertonic saline-epinephrine injection group (n=16) or ethanol plus hypertonic saline-epinephrine injection group (n=33).
RESULTS
No difference in initial hemostasis, rebleeding, need for operation, transfusion requirement, hospital stay and mortality was observed among the ethanol, hypertonic saline-epinephrine and ethanol plus hypertonic saline-epinephrine group. The rate of initial hemostasis in patients with Dieulafoy ulcer bleeding was significantly lower than patients with non-Dieulafoy ulcer bleeding. The rate of initial hemostasis failure, rebleeding rate, need for operation, transfusion requirement and mortality were higher in patients with spurting hemorrhage than patients with visible vessels. Hypertension, diabetus mellitus, smoking and alcohol drinking did not influence therapeutic effect of injection therapy.
CONCLUSION
There is no difference in the therapeutic effect of endoscopic injection for peptic ulcer bleeding among ethanol, hypertonic saline-epinephrine and ethanol plus hypertonic saline-epinephrine group, but the therapeutic effect of injection therapy is low in patients with Dieulafoy ulcer bleeding and spurting hemorrhage. Therefore, combination therapy with injection therapy and another endoscopic therapy or another endoscopic therapy alone should be considered.