Although the initial rate of hemostasis achieved by endoscopic epinephrine injection for peptic ulcer bleeding is high, bleeding recurs in 14.6% to 35.5% of patients.
Dr Park and colleagues from Korea undertook a study in order to compare rates of recurrent bleeding after endoscopic injection of 2 different volumes of epinephrine in patients with peptic ulcer bleeding.
The researchers randomly assigned a total of 72 patients with peptic ulcer and active bleeding or a non-bleeding visible vessel to either 15 to 25 mL or 35 to 45 mL injections of a 1:10,000 solution of epinephrine.
The research team ensured that the 2 groups were similar with respect to all background variables.
| Hemostasis was achieved in 97.2% of patients in the 15 to 25 mL group and 100% of patients in the 35 to 45 mL group|
The investigators injected a mean volume of epinephrine of 19.4 mL in the 15 to 25 mL group and 41.1 mL in the 35 to 45 mL group.
The researchers found that initial hemostasis was achieved in 97.2% of patients in the 15 to 25 mL group and in 100% of patients in the 35 to 45 mL group.
The researchers noted that the 35 to 45 mL volume was significantly more effective in preventing recurrent bleeding than the 15 to 25 mL volume.
In addition, the research team found that for ulcers in the gastric body, the 35 to 45 mL volume was significantly more effective in preventing recurrent bleeding than the 15 to 25 mL volume.
For ulcers in other locations, including the gastric antrum and the duodenum, there were no significant differences in the rate of recurrent bleeding between the two groups.
Dr Park concluded, "Injection of 35 to 45 mL of a 1:10,000 solution of epinephrine is more effective than injection of 15 to 25 mL of the same solution for prevention of recurrent bleeding from ulcers in the body of the stomach."