Upper GI bleed: endoscopic injections of epinephrine in patients with peptic ulcer reduced the need for emergency surgery

Clinical bottom line (level 1b)

  1. Patients with upper GI bleeds due to actively bleeding peptic ulcers who received endoscopic injections of epinephrine were less likely to require emergency surgery (NNT = 5 at unknown) .
  2. There was no clear effect on mortality.
Chung et al: British Medical Journal 1988; 296: 1631-1633
Expires November 2002

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, Hong Kong

68 patients (aged mean 53, 76.47% male) with upper gastrointestinal haemorrhage due to actively bleeding ulcers

Excluded if
  • bleeding only on contact with endoscope; visible blood vessels not bleeding; blood clots covering base of ulcer; no signs of recent haemorrhage on endoscopy


    • Note:
  • All patients received cimetidine or ranitidine following endoscopy.


Control Group: (n = 34, 34 analysed): endoscopy
Experimental Group: (n = 34, 34 analysed): endoscopy and injection of epinephrine into and around the bleeding point until bleeding had stopped

100% followed for ? length of hospital stay
Outcome notes:
  • emergency surgery : rebleed associated with signs of shock, or failure to stabilise after 4 units of blood, or transfused more than 8 units of blood

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
emergency surgery weeks 14
(41.2%)		 5
(14.7%)		 64%
(12% to 86%)		 26.47%
(6.09% to 46.85%)		 4
(2 to 16)
death weeks 2
(5.88%)		 3
(8.82%)		 -50%
(-740% to 73%)		 -2.94%
(-15.3% to 9,45%)		 -34
(NNT = 11 to infinity;
NNH = 7 to infinity)

Comments

  1. The study is too small to show any clear difference in mortality between the two groups.

    Citation

    1. Chung SC, Leung JW, Steele RJ, et al: Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. British Medical Journal 1988; 296: 1631-1633
    Search Terms: ?
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer: Horand Meier

    Clinical Question.
    Patient actively bleeding peptic ulcer
    Intervention or Exposure endoscopic injection of epinephrine
    Outcome emergency surgery, death