Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleeding

Table 1 Clinical and endoscopic variables of patients at study entry (n = 76, mean±SD)

	Epinephrine(20 mL) n (%)	Epinephrine(30 mL) n (%)	Epinephrine(40 mL) n (%)
Age (yr)	61.5 ± 12.8	60.2 ± 13.3	62.3 ± 12.5
Gender (M/F)	56/20	53/23	55/21
NSAID ingestion	26 (34.2)	24 (31.6)	27 (35.5)
Shock	20 (26.3)	23 (30.3)	21 (27.6)
Comorbid illness	43 (56.6)	41 (53.9)	45 (59.2)
Hb level (g/dL)	7.2 ± 2.8	7.5 ± 2.6	7.6 ± 2.7
Coagulopathy	12 (15.8)	10 (13.2)	13 (17.1)
Positive H pylori	44 (57.9)	43 (56.6)	47 (61.8)
Forrest class
Ia	18 (23.7)	20 (26.3)	19 (25.0)
Ib	58 (76.3)	56 (73.7)	57 (75.0)
Ulcer size
≥2 cm	20 (26.3)	22 (28.9)	23 (30.3)
<2 cm	56 (73.7)	54 (71.1)	53 (69.7)
Location of ulcer
Stomach	41 (53.9)	40 (52.6)	44 (57.9)
Duodenum	32 (42.1)	34 (44.7)	30 (39.5)
Stoma	3 (3.9)	2 (2.6)	2 (2.6)

NSAID: non-steroid anti-inflammatory drug. P > 0.05 for all variables between the three groups.

Table 2 Clinical outcomes of endoscopic injection therapy

	Epinephrine(20 mL) n (%)	Epinephrine(30 mL) n (%)	Epinephrine(40 mL) n (%)
Initial hemostasis	74 (97.4)	75 (98.7)	76 (100)
Recurrent bleeding	15/74 (20.3)b	4/75 (5.3)	2/72 (2.8)
Perforated peptic ulcer	0 (0)	0 (0)	4 (5.3)a
Surgical intervention	4 (5.3)	2 (2.6)	5 (6.6)
Transfusion requirement (units)	4.7 ± 3.4	4.5 ± 3.2	4.2 ± 3.6
Total hospital stay (days)	10.8 ± 3.3	9.7 ± 3.5	10.2 ± 3.1
Deaths from bleeding	0 (0)	0 (0)	0 (0)
30-d mortality	3 (3.9)	2 (2.6)	4 (5.3)
No. of patients that felt pain'	2 (2.6)	5 (6.6)	51 (67.1)d

^aP < 0.05 vs the 20 mL and 30 mL epinephrine groups;

^bP < 0.01 vs the 30 mL and 40 mL epinephrine groups;

^dP < 0.001 vs the 20 mL and 30 mL epinephrine groups;' Epigastric pain induced by endoscopic injection of epinephrine.

Table 3 Changes in systolic blood pressure and pulse before and after endoscopic injection therapy (n = 76, mean±SD)

	Epinephrine(20 mL) n (%)	Epinephrine(30 mL) n (%)	Epinephrine(40 mL) n (%)
Pressure (mmHg)
Before treatment	108.2 ± 31.8	109.3 ± 29.3	106.2 ± 30.7b
After treatment	110.3 ± 21.9	112.7 ± 22.5	129.3 ± 25.8b
Pulse (/min)
Before treatment	96.5 ± 14.7d	98.2 ± 15.3d	96.7 ± 14.3
After treatment	84.8 ± 12.8d	86.3 ± 12.5d	101.4 ± 15.2

^bP < 0.01 (paired t-test) in the 40 mL epinephrine group;

^dP < 0.01 (paired t-test) in the 20 mL and 30 mL epinephrine groups.