Comparison of Endoscopic Injection with Hypertonic Saline-Epinephrine(HSE) and Absolute Ethanol for Bleeding Peptic Ulcers

Chung, Jung Myung; Lee, Sang Hyuk; Lee, Youn Jae; Seol, Sang Young; Park, Eun Taik; Lee, Sang Wook

Abstract

BACKGROUND/AIMS: The endoscopic injection therapy with hypertonic saline-epinephrine(HSE) and absolute ethanol are the most widely and easily used procedure in the management of patients with bleeding peptic ulcers. We performed a prospective, randomized trial to compare the hemostatic efficacy between HSE and absolute ethanol injection therapy.
METHODS
During the period of 1993 to 1996, 60 patients who were identified as active bleeding or visible vessel were enrolled for this trial. The 60 patients were randomly divided into two groups(HSE group, 30 cases: ethhnol group, 30 cases). We performed endoscopic injection therapy with 3% saline and 1:10,000 epinephrine solution in HSE group, and with 99.5% absolute ethanol in ethanol group. The two groups were matched for sex, age, site of bleeding, endoscopic findings, initial hemoglobin, and concomitant illness at randomization.
RESULTS
Bleeding was initially controlled in 21(70%) of the HSE group and in 29(96.7%) of the ethanol group(p < 0.05). Rebleeding occurred in 4(19%) of the HSE group and in 2(6.9%) of the ethanol group(p < 0.1). The ethanl group achieved a better hemostatic effect for spurting hemorrhage(3/13 vs 9/10, p < 0.05). The emergent operations were undergone in 10(33.3%) and 2(6.7%) for HSE group and ethanol group respectively(p < 0.01). The stay in hospital were less than in ethanol group(mean 9.5 vs 16.3, p < 0.01). The death were noticed in 6 cases(20%) in HSE group and 1 case(3.3%) in ethanol group(p < 0.05).
CONCLUSIONS
This study shows that absolute ethanol injection is more efficaceous and better satisfactory method in peptic ulcer bleeding.