Abstract
Fifty-two patients with Forrest Ia or Ib bleeding ulcers were randomized to receive
endoscopic injection therapy with either 1:10000 epinephrine in water (Group I) or
distilled water (Group II). Twenty-five out 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 bleeding
controlled by heater probe thermocoagulation or surgical intervention. Three patients
in each group developed rebleeding after initial hemostasis. Four of these patients
had bleeding controlled by surgical intervention, 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 higher rebleeding rate after initial
hemostasis than patients with normal blood pressure and ulcers under 2 cm (p < 0.05).
No serious complications were observed after injection therapy, and no significant
difference in the amounts of solution required for successful hemostasis was noted
between the two groups. We conclude that a local tamponade with distilled water is
as effective and safe as diluted epinephrine solution for endoscopic injection therapy.
