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Medline ® Abstract for Reference 61

of 'Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding'

Treating delayed endoscopic sphincterotomy-induced bleeding: epinephrine injection with or without thermotherapy.
Tsou YK, Lin CH, Liu NJ, Tang JH, Sung KF, Cheng CL, Lee CS
World J Gastroenterol. 2009;15(38):4823.
AIM: To compare the hemostatic efficacy between epinephrine injection alone and epinephrine injection combined with thermotherapy for delayed post-endoscopic sphincterotomy (ES) bleeding.
METHODS: Cases with delayed post-ES bleeding undergoing epinephrine injection alone (epinephrine injection group, n = 26) or epinephrine combined with thermotherapy (combination therapy group, n = 33) in our institution between 1999 and 2007 were retrospectively investigated. The main outcome measurements were: initial endoscopic hemostasis, re-bleeding, complications, requirement of angiographic embolization or surgery, requirement for blood transfusion, and mortality.
RESULTS: The initial hemostatic efficacy was 96.2% for epinephrine injection alone and 100% for combination therapy (P = 0.44). There were four patients with re-bleeding in each group (16.0% vs 12.1%, P = 0.72). There was only one complication of pancreatitis from the combination therapy group. Three patients (11.5%) in the epinephrine injection group and one patient(3%) in the combination therapy group required angiographic embolization or surgery (P = 0.31). The total number of blood transfusions was not significantly different between the two groups (3.5 +/- 4.6 U vs 3.5 +/- 4.5 U, P = 0.94). There was no bleeding-related death in either group.
CONCLUSION: Epinephrine injection alone is as effective as epinephrine injection combined with thermotherapy for the management of delayed post-ES bleeding.
Department of Hepato-Gastroenterology, Division of Therapeutic Endoscopy, Chang Gung Memorial Hospital&Chang Gung University College of Medicine, Taipei, Taiwan, ROC.