To date several agents have been used to achieve hemostasis in patients with bleeding peptic ulcers using endoscopic sclerotherapy techniques. In this study, the efficacy of endoscopic local injections of hypertonic saline-epinephrine(HS-E)
solution,
consisting of 9 volume of 3% sodium chloride and 1 volume of 1:1000 epinephrine, on the base of the ulcer around bleeding vessel was assessed. Duing the period between April 1989 and July 1992, 127 patients were admitted to the study. Ninety-six
of
these patients underwent endoscopic treatment(endoscopic treatment group), while the other 31 cases received conservative treatment only(conservative treatment group).
1) These patients consisted of 110 men and 17 women with an age range of 15 to 81 years (mean, 49.6 years). Comparing the two groups, there was n significant difference in terms of age and sex.
2) Causes of bleeding included gastric ulcer, 79(62,2%) and duodenal ulcer, 48(37.8%). There was no significant difference between the two groups in the location of ulcer.
3) There were 48 active bleeding(spurting, 19:oozing, 29) and 79 stigmata of recent hemorrhage9visible vessel, 62; fresh blood clots, 17). There were no statistically significant difference between the two groups in terms of endoscopic stigmata.
4) Initial hemostasis was achieved in 93 patients(96.9%) of endoscopic treatment group, whereas only in 23 patients(74.2%) of conservative treatment group(p<0.01).
5) After initial treatment, 22 of 93 patients in endoscopic treatment group(23.7%) and 10 of 23 patients in conservative treatment group had recurrent bleeding(p<0.05). In cases with visible vessel, the rebleeding rate in endoscopic treatment
group(16.7%) was significantly lower than in conservative treatment group(50.0%)(p<0.01).
6) Six patients(6.3%) in endoscopic treatment group ad 16 patients(51.6%) in conservative treatment group underwent surgery due to persistent or recurrent bleeding(p<0.01). Mortality was lower in endoscopic treatment group(6.3%) than in
conservative
treatment group(19.4%)(p<0.0%).
7) Overall, permanent hemostasis was achieved in 87 patients(90.6%) of endoscopic treatment group, whereas only in 13 patients(41.9%) of conservative treatment group(p<0.01).
8) According to stigmata of recent hemorrhage, 11 of 14 patients(78.6%) with spurting, 24 of 26 patients(92.3%) with oozing, 46 of 48 patients(95.8%) with visible vessel, and 6 of 8 patients (75.0%) with fresh blood clot could be managed
successfully
by endoscopic injection of HS-E solution. However, in conservative treatment group, no hemostasis was achieved in patients with spurting or oozing and 7 of 14 patients(50.0%) with visible vessel, and 6 of 9 patients(66.7%) with blood clot
ultimately
ceased bleeding with supportive management.
In conclusion, endoscopic injection of hypertonic saline-epinephrine solution is very effective as well as safe and simple in control of active bleeding or prevention of rebleeding in peptic ulcer bleeding.
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