A prospective, randomized trial of large-versus small-volume endoscopic injection of epinephrine for peptic ulcer bleeding

Hwai Jeng Lin, Yu Hsi Hsieh, Guan Ying Tseng, Chin Lin Perng, Full Young Chang, Shou Dong Lee

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110 Citations (Scopus)


Background: Endoscopic injection of epinephrine in the treatment of bleeding peptic ulcer is considered highly effective, safe, inexpensive, and easy to use. However, bleeding recurs in 6% to 36% of patients. The aim of this study was to determine the optimal dose of epinephrine for endoscopic injection in the treatment of patients with bleeding peptic ulcer. Methods: One hundred fifty-six patients with active bleeding or nonbleeding visible vessels were randomized to receive small- (5-10 mL) or large-volume (13-20 mL) injections of a 1:10,000 solution of epinephrine. Results: The mean volume of epinephrine injected was 16.5 mL (95% CI [15.7, 17.3 mL]) in the large-volume group and 8.0 mL (95% CI [7.5, 8.4 mL]) in the small-volume group. Initial hemostasis was achieved in all patients studied. The number of episodes of recurrent bleeding was smaller in the large-volume group (12/78, 15.4%) compared with the small-volume group (24/78, 30.8%, p = 0.037). 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 2 groups. Conclusions: Injection of a large volume (> 13 mL) of epinephrine can reduce the rate of recurrent bleeding in patients with high-risk peptic ulcer and is superior to injection of lesser volumes of epinephrine when used to achieve sustained hemostasis.

Original languageEnglish
Pages (from-to)615-619
Number of pages5
JournalGastrointestinal Endoscopy
Issue number6
Publication statusPublished - May 2002
Externally publishedYes


ASJC Scopus subject areas

  • Gastroenterology

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