Upper GI bleed: no clear benefit from adding ethanolamine to epinephrine for injection therapy for bleeding peptic ulcer.

Clinical bottom line (level 1b-)

  1. Patients with bleeding peptic ulcers who had ethanolamine and epinephrine injection therapy compared with epinephrine alone were not clearly less likely to rebleed or require surgery.
Choudari and Palmer: Gut 1994; 35: 608-610
Expires October 2002

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: 4 acute hospitals, UK

107 patients (aged 23 to 95; mean ~69, 64% male) with upper GI bleeding due to a peptic ulcer and any of the following risk factors
  • older than 60
  • initial Hb < 100 g/l or shock (defined as pulse > 100 beats/minute or systolic blood pressure < 100 mmHg)


Excluded if
  • initial haemostasis could not be achieve with epinephrine alone
  • failure to identify bleeding point
  • ulcer inaccessible to injection


    • Note:
  • All patients had resuscitation endoscopy, and a repeat endoscopy at 24 to 48 hours if there was active bleeding at presentation or initial therapy was thought suboptimal.


Control Group: (n = 55, 55 analysed): 1:100 000 epinephrine into and around bleeding vessel
Experimental Group: (n = 52, 52 analysed): 1: 100 000 epinephrine and 5% ethanolamine 0.2 to 2.0 ml into and around bleeding vessel.

100% followed for 30 days

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
rebleeding 30 days 8
(14.6%)		 7
(13.5%)		 7%
(-137% to 64%)		 1.08%
(-12.06% to 14.2%)		 92
(NNT = 7 to infinity;
NNH = 8 to infinity)
surgery 30 days 4
(7.27%)		 4
(7.69%)		 -6%
(-301% to 72%)		 -0.42%
(-10.4% to 9.56%)		 -238
(NNT = 10 to infinity;
NNH = 10 to infinity)

Comments

  1. "High risk" group in this study.
  2. The study is too small to show any difference between the two groups.

    Citation

    1. Choudari CP, and Palmer KR: Endoscopic injection therapy for bleeding peptic ulcer: a comparison of adrenaline alone with adrenaline plus ethanolamine oleate. Gut 1994; 35: 608-610
    Contributor: Chris Ball and Musab Hayatli, October 1999
    Reviewer: Lawrence Friedman

    Clinical Question.
    Patient active bleeding ulcer
    Intervention or Exposure ethanolamine added to epinephrine
    Comparison epinephrine alone
    Outcome mortality, rebleeding