Adding a sclerosant to endoscopic epinephrine injection in actively bleeding ulcers: a randomized trial

Area of Science:

• Gastroenterology
• Endoscopic hemostasis
• Gastrointestinal bleeding management

Background:

• Active ulcer bleeding is a significant cause of gastrointestinal bleeding.
• Endoscopic interventions are crucial for managing actively bleeding ulcers.
• Epinephrine injection is a common first-line endoscopic therapy.

Purpose of the Study:

• To compare the efficacy of epinephrine injection alone versus epinephrine injection followed by sodium tetradecyl sulfate for controlling active ulcer bleeding.
• To evaluate the added benefit of sodium tetradecyl sulfate in endoscopic hemostasis.
• To assess outcomes such as need for emergency surgery, blood transfusion, and mortality.

Main Methods:

• A randomized controlled trial involving 200 patients with actively bleeding ulcers.
• Patients received either epinephrine injection alone or epinephrine injection plus sodium tetradecyl sulfate.
• Outcomes were assessed based on hemostasis rates, need for repeat intervention, emergency surgery, transfusion requirements, hospital stay, and mortality.

Main Results:

• Initial hemostasis was achieved in 94% of the epinephrine group and 97% of the epinephrine plus sodium tetradecyl sulfate group.
• No significant differences were observed between the two groups regarding emergency surgery, blood transfusion, hospital stay, or mortality.
• Both treatment strategies demonstrated high initial hemostasis rates.

Conclusions:

• Endoscopic epinephrine injection is an effective monotherapy for controlling active ulcer bleeding.
• The addition of sodium tetradecyl sulfate to epinephrine injection does not offer a significant advantage in improving outcomes for bleeding ulcers.
• Epinephrine injection alone is sufficient for achieving hemostasis in most cases of active ulcer bleeding.