EPINEPHRINE OR EPINEPHRINE PLUS ALCOHOL FOR INJECTION OF BLEEDING ULCERS - A PROSPECTIVE RANDOMIZED TRIAL

Background: Rebleeding following epinephrine injection of bleeding pep tic ulcers occurs in 10% to 20% of all cases. The addition of a sclero sant has the theoretical advantage of inducing vessel thrombosis and p ermanent hemostasis. Methods: A prospective randomized controlled tria l was conducted to compare injections with epinephrine alone or epinep hrine plus absolute alcohol in patients with actively bleeding ulcers at endoscopy. Repeat endoscopy was performed 24 hours later; treatment was repeated in the presence of endoscopic signs of rebleeding. Surge ry was performed when arterial bleeding could not be controlled endosc opically, clinical rebleeding with hematemesis or shock occurred, or t he transfusion total exceeded 8 units. Results: One hundred sixty pati ents were enrolled (epinephrine alone, 81; epinephrine and absolute al cohol, 79). They were matched in age, sex, location of ulcers, hemoglo bin on admission, shock, and severity of bleeding. Initial hemostasis was comparable: 79 of 81 with epinephrine alone (97.5%) versus 75 of 7 9 with epinephrine and absolute alcohol (94.9%). No difference was obs erved between the two with respect to either rebleeding (9 vs 6), need for emergency operation (12 vs 9), transfusion requirement (median, t hree units vs two units), hospital stay (median, 5 days vs 4 days), mo rtality (4 vs 7) and ulcer healing at 4 weeks (50 vs 46). Conclusions: The additional injection of absolute alcohol after endoscopic epineph rine injection confers no advantage.