Hemostatic Effect of Endoscopic Injection with Hypertonic Saline Epinephrine for Peptic Ulcer Bleeding

Cho, Cheon Yeong; Oh, Won Tae; Choi, Sung Kyu; Ahn, Hyun Taek; Koo, Cheol; Kim, Hyun Su; Rew, Jong Sun; Kim, Sei Jong

Abstract

Endoscopic injection therapy using various different agents (ethanol, polidocanol, epinephrine with and without hypertonic saline, etc) is considered as the least expensive and effective technique to obtain hemostasis in peptic ulcer bleeding. The endoscopic injection therapy with hypertonic saline epinephrine(HSE) is the most widely and easily used procedure in the management of patients with bleeding peptic ulcers. We performed endoscopic injection therapy with 3% saline and 1:10,000 epinephrine solution among twenty five patients with peptic ulcer bleeding from January, 1997 to December, 1997 in whom active bleeding(spurting, oozing), a visible vessel and fresh red blood coagula adherent to ulcer base was identified. The results were as follows: 1) The mean age of patients was 61.7 years and the ratio of male to female was 5.3:1. Sixteen patients(64%) were accompanied with other systemic diseases. 2) The source of bleeding was gastric ulcer in 21 cases(84%) and duodenal ulcer in 4 cases(16%). The mean ulcer size was 1.2 cm and the multiple ulcer was seen in 13 cases(52%). As the stigma of bleeding, spurting were seen in 5 cases(20%), oozing in 9 cases(36%), visible vessel in 9 cases(36%) and fresh red adherent coagula in 2 cases(8%). 3) Bleeding was initially controlled in 24 cases(96%). The rebleeding was occurred in 8 cases(33%) and rebleeding was controlled in 7 cases(87%). The emergent operation was undergone in 2 cases(8%). Delayed rebleeding after 3 weeks was occurred in 2 cases(8.7%). 4) Mild epigastralgia after injection therapy in 4 case(16%) was noted but the complications and death were not noticed. This study shows that hypertonic saline epinephrine injection therapy is safe and effective method in treating of peptic ulcer bleeding.