Epinephrine or epinephrine plus alcohol for injection of bleeding ulcers: a prospective randomized trial☆,☆☆,★,★★,♢
Section snippets
PATIENTS AND METHODS
All patients presenting with acute upper gastrointestinal bleeding to the Prince of Wales Hospital, Hong Kong, were admitted to the Department of Medicine and were examined with an endoscope within 24 hours of admission. Patients admitted with fresh hematemesis and patients with hemodynamic instability were examined with an endoscope as soon as they had been resuscitated. Informed consent to possible endoscopic therapy was obtained for all patients before endoscopy. Endoscopy was carried out
RESULTS
From January 1991 to July 1992, 2551 patients were admitted to the Prince of Wales Hospital with upper gastrointestinal hemorrhage. Fifteen patients with actively bleeding ulcers were not randomized. (Bleeding sites were not clearly identified in 6 patients because of brisk bleeding; they all underwent immediate surgery. One patient was not cooperative during endoscopy, and 8 patients were excluded because of violation of protocol.) One hundred sixty patients with actively bleeding ulcers thus
DISCUSSION
Endoscopic hemostasis is now increasingly used as the first line of treatment for patients with ulcer bleeding. Laser photocoagulation, heat probe treatment, multipolar electrocoagulation, and injection have been shown to be clinically useful and to alter the outcome in patients with ulcer bleeding.2, 3, 19, 20, 21, 22, 23, 24, 25 Bleeding from peptic ulcers, however, stops spontaneously in 70% to 80% of patients. Indiscriminant treatment of low-risk stigmata is unwarranted and may be harmful.
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From the Departments of Surgery and Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Reprint requests: Arthur K.C. Li, MD, Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
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37/1/68882
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0016-5107/96/4306-0591$5.00 + 0
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GASTROINTESTINAL ENDOSCOPY