ENDOSCOPIC INJECTION FOR THE TREATMENT OF BLEEDING ULCERS - LOCAL TAMPONADE OR DRUG EFFECT

Fifty-two patients with Forrest Ia or Ib bleeding ulcers were randomiz ed to receive endoscopic injection therapy with either 1:10 000 epinep hrine in water (Group I) or distilled water (Group II). Twenty-five ou t of 27 patients in group I, versus 22 out of 25 patients in group II, achieved initial hemostasis after endoscopic injection therapy (p > 0 .05). Five patients who did not respond to local injection had bleedin g controlled by heater probe thermocoagulation or surgical interventio n. Three patients in each group developed rebleeding after initial hem ostasis. Four of these patients had bleeding controlled by surgical in tervention, while the other two died of underlying diseases. No change in systemic blood pressure, but a significant drop in the pulse rate were noted in both groups after injection therapy. Patients with shock at admission or ulcer size greater than 2 cm had a significantly high er rebleeding rate after initial hemostasis than patients with normal blood pressure and ulcers under 2 cm (p < 0.05). No serious complicati ons were observed after injection therapy, and no significant differen ce in the amounts of solution required for successful hemostasis was n oted between the two groups. We conclude that a local tamponade with d istilled water is as effective and safe as diluted epinephrine solutio n for endoscopic injection therapy.