ADDING A SCLEROSANT TO ENDOSCOPIC EPINEPHRINE INJECTION IN ACTIVELY BLEEDING ULCERS - A RANDOMIZED TRIAL

We compared the efficacy of epinephrine injection and epinephrine inje ction followed by sodium tetradecyl sulfate in controlling active ulce r bleeding. Out of 2814 patients who underwent endoscopy for gastroint estinal bleeding, 200 patients with actively bleeding ulcers seen at t he time of endoscopy were randomized to receive epinephrine injection alone (99 patients) or epinephrine injection followed by 3% sodium tet radecyl sulfate (101 patients). After the procedure the patients were transferred to the surgical gastroenterology ward and were treated by surgeons who were unaware of the mode of treatment. The patients under went routine endoscopy 24 hours later, and epinephrine injection was r epeated if active bleeding was seen again. Emergency surgery was perfo rmed for the following: (1) arterial spurting not controlled endoscopi cally, (2) failure of the blood pressure or pulse to stabilize after 4 units of blood, (3) total transfusion of more than 8 units of blood, or (4) rebleeding as defined by hematemesis with pulse greater than 10 0 beats/min or blood pressure less than 100 mm Hg after stabilization. The two groups were comparable in age, sex, site of ulcer, and severi ty of bleeding. Initial hemostasis was obtained at the time of endosco py in 94% of the epinephrine group and 97% of the epinephrine plus sod ium tetradecyl sulfate group. No difference in outcome was seen in the two groups as measured by emergency surgery requirement, blood transf usion, hospital stay, and hospital mortality. Endoscopic epinephrine i njection is effective in controlling active ulcer bleeding. The additi onal injection of sodium tetradecyl sulfate confers no additional adva ntage.