Investigators from Taiwan, People's Republic of China, determined the optimal dose of epinephrine for endoscopic injection in the treatment of patients with bleeding peptic ulcer.
A total of 156 patients with active bleeding or nonbleeding visible vessels were included in the trial.
They were randomized to receive small- (5-10 ml) or large-volume (13-20 ml) injections of a 1:10,000 solution of epinephrine.
The mean volume of epinephrine injected was 16.5 ml in the large-volume group and 8.0 ml in the small-volume group.
|Recurrent bleeding episodes:|
Large-volume injection: 15%
| Gastrointestinal Endoscopy |
Initial hemostasis was achieved in all patients studied.
The number of episodes of recurrent bleeding was smaller in the large-volume group (15%) compared with the small-volume group (31%).
The volume of blood transfused after entry into the study, duration of hospital stay, numbers of patients requiring urgent surgery, and mortality rates were not statistically different between the two groups.
Dr Hwai-Jeng Lin, of the Veterans General Hospital, Taipei, Taiwan, concluded on behalf of colleagues, "Injection of a large volume (> 13 ml) of epinephrine can reduce the rate of recurrent bleeding in patients with high-risk peptic ulcer.
"It is also superior to injection of lesser volumes of epinephrine when used to achieve sustained hemostasis."