소화성궤양 출혈에 대한 Hypertonic Saline-Epinephrine 용액의 내시경적 국소주사의 지혈효과 = Hemostatic Effect of Endoscopic Local Injection of Hypertonic Saline-Epinephrine Solution in Peptic Ulcer Bleeding

다국어 초록 (Multilingual Abstract)

To date several agents have been used to achieve hemostasis in patients with bleeding peptic ulcers using endoscopic sclerotherapy techniques. In this study, the efficacy of endoscopic local injections of hypertonic saline-epinephrihe(HS-E) solution, consisting of 9 volume of 3% sodium chloride and 1 volume of 1: 1000 epinephrine, on the base of the ulcer around bleeding vessel way assemased. During the period between April 1989 and July 1992, 127 patients were admitted to the study. Ninety-six of these patients underwent endoscopic treatment(endoscopic treatment group), while the other 31 cases received conserative treatment only(conservative treatment group).
1) Them patients consisted of 110 men and 17 women with an age range of 15 to 81 years (mean, 49.5 years). Comparing the two groups, there was no significant difference in terms of age and sex.
2) Causes of bleeding included Bastric ulcer, 79(62.2%) and duodenal ulcer 48(37.8%). There was no significant difference between the two groups in the location of ulcer.
3) There were 48 active bleeding(spurting, 19; oozing, 29) and 79 stigmata of recent hemorrhage(visible vessel, 62; fresh blood clots, 17). There were no statistically significant difference between the two groups in terms of endoecopic stigmta.
4) Initial hemostasis was achieved in 93 patient(96.9%) of endoscopic treatment group, whereas only in 23 patients(74:2%) of conservative treatment group(p$lt;0.01).
5) After initial treatment, 22 of 93 patients in endoscopic treatment group(23.7%) and 10 of 23 patients in conservative treatment group had recurrtht bleeding(p$lt;0.05). In cases with visible vessel, ties rebleeding note in endoscopic treatment group(16.7%) was significantly lower than in conservative treatment group(50.0%)(p$lt;0.01).
6) Six patients(6.3%) in endascopic treatment group and 16 patients(51.6%) in conservative treatment group underwent emergency surgery due to persistent or recurrent bleeding(p $lt; 0.01). Mortality was lower in endoscopic treatment group(6.3%) than in conservative treatment group(19.4%)(p$lt;0.05).
7) Overall, permanent hemostasis was achieved in 87 patients(90.6%) of endoscopic treatment group whereas only in 13 patients(41.9%) of conservative treatment group(p$lt;0.01).
8) According to stigmata of recent hemorrhage, 11 of 14 patients(78.6%) with spurting, 24 of 26 patients(92.3%) with nosing, 46 of 48 patient(95.8%) with visible vessel, and 6 of 8 patients (75.0%) with fresh blood clot could be managed successfully by endoscopic infection of HS-E solution. However, in conservative treatment group, na homostasis was achieved in patients with spurting or oozing and 7 of 14 petients(50.5%) with visible vessel, and 6 of 9 patients(66.7%) with blood clot ultimately ceased bleeding with supportive management.
In conclusion, endoscopic injection of hypertonic saline-epinephrine solution is very effective as well as safe and simple in control of active bleeding or prevention of rebleeding in peptic ulcer bleeding.