Hypertonic Saline-epinephrine Solution Research Articles

How to Perform a High-Quality Endoscopic Submucosal Dissection

How to Perform a High-Quality Endoscopic Submucosal Dissection

Prophylactic Injection of Hypertonic Saline-epinephrine Oral to the Papilla for Prevention of Postsphincterotomy Bleeding

Endoscopic injection of hypertonic saline-epinephrine (HSE) solution oral to the papilla effectively arrests uncontrolled bleeding after endoscopic sphincterotomy (ES). The aim of this study was to evaluate the efficacy of a prophylactic injection of HSE solution oral to the papilla before ES for prevention of post-ES bleeding. Patients scheduled for ES were recruited into this study. Before ES, patients randomly underwent a single submucosal injection of HSE solution (1 mL) 1 to 2-cm oral to the papilla (injection group) or no injection (noninjection group). After ES, patients were prospectively evaluated for occurrence of post-ES complications such as bleeding, perforation, and pancreatitis between the groups. A total of 120 patients were randomized to the injection group (n=60) or the noninjection group (n=60). The 2 groups were similar with respect to all background variables. Bleeding occurred in 10 patients (8.3%), and the incidence of bleeding was significantly higher in the noninjection group (9/60) than in the injection group (1/60) (P=0.017). Retroperitoneal perforation occurred in 1 patient (injection group) (0.83%). Pancreatitis occurred in 10 patients (8.3%), and the incidence of pancreatitis tended to be higher in the noninjection group (8/60) than in the injection group (2/60) (P=0.095). Prophylactic injection of HSE solution oral to the papilla before ES is a simple and inexpensive method, and is effective for prevention of post-ES bleeding.

Splenic infarction and abscess after endoscopic injection of hypertonic saline-epinephrine solution administered for bleeding gastric ulcer

Splenic infarction and abscess after endoscopic injection of hypertonic saline-epinephrine solution administered for bleeding gastric ulcer

Successful endoscopic hemostasis for bleeding from an acquired ileal diverticulum.

We herein report successful endoscopic hemostasis in a patient with a bleeding from acquired ileal diverticulum. A 65-year-old woman was introduced to our hospital after the sudden onset of painless hematochezia. When emergency colonoscopy was performed, the site of bleeding could not be identified because of extensive blood pooling in the colon and ileocecal region. After admission, repeat colonoscopy with a transparent hood device after bowel preparation disclosed oozing of blood from an ileal diverticulum approximately 15 cm proximal to the ileocecal junction. We performed endoscopic therapy with injection of a hypertonic saline-epinephrine solution and placement of additional hemoclips in the diverticulum. Since the latter treatment, the patient had no recurrent hematochezia, and occult blood tests in stool had been negative. In cases of lower gastrointestinal bleeding, bleeding from an acquired ileal diverticulum should be considered and the terminal ileum carefully observed.

Efficacy of Argon Plasma Coagulation in Nonvariceal Upper Gastrointestinal Bleeding

Various methods of endoscopic hemostasis have been described. However, few reports have investigated the efficacy of argon plasma coagulation (APC) in the treatment of upper gastrointestinal bleeding. The aim of this study was to evaluate the efficacy of APC in various types of upper gastrointestinal bleeding. The present study was designed as a prospective and observational study. A total of 254 consecutive patients with upper gastrointestinal bleeding (excluding variceal bleeding) were primarily treated using APC. If it was difficult to achieve complete hemostasis with APC alone, injection of a hypertonic saline-epinephrine solution and clipping were carried out. The initial hemostasis rate, rate of recurrent bleeding after APC, permanent hemostasis rate, and mean procedure time were evaluated. Initial hemostasis with APC alone was achieved in 193 of the 254 patients (75.9 %). With the assistance of other methods as well, initial hemostasis was achieved in 253 patients (99.6 %). Among the 193 patients treated with APC alone, recurrent bleeding was observed in 11 cases (11 of 193, 5.7 %). With one exception, these cases of recurrent bleeding were controlled with APC alone again; permanent hemostasis was thus ultimately achieved with APC alone in 192 of the 254 patients (75.5 %). The mean procedure time was 8 min. No complications (such as perforation) were observed with the APC treatment. These data indicate that APC is a safe, quick, and effective method of treating various types of nonvariceal upper gastrointestinal bleeding and that it can be a powerful tool for endoscopic hemostasis.

Hello, Mr. Clips—could you chip in please?

Hello, Mr. Clips—could you chip in please?

早期胃癌に対するエピネフリン加高張食塩水局注を併用した内視鏡的切除法

われわれが1994年8月までに早期胃癌に対してERHSEを実施した成績をもとに，ERHSEの適応について検討した。症例の内訳は男38例，女24例，平均年齢73.9±8.7歳であった。肉眼型はⅠ型5例，Ⅱa28例，Ⅱb3例，Ⅱc22例，Ⅱa＋Ⅱc2例，Ⅱc＋Ⅱa2例で，組織型は全例分化型であった。深達度はm52例，sm1 8例，m，smの判定不能2例であった。病変の長径は平均14mmであった。合併症は狭心症発作1例，出血2例，穿孔4例認めたが，いずれも保存的に治癒した。一括切除は46例74％で，切除断端癌陰性は42例，切除断端癌陽性は3例（うち1例は胃切除で癌遺残なしを確認）で，1例は病変を回収できなかったが，術後130カ月間癌陰性である。分割切除は16例26％で，うち再発例は5例である。従って，初回治療切除率は一括切除例が96％（44/46），分割切除例が69％（11/16）であった。一括切除病変は，深達度を含めた切除断端の病理学的検索が十分にできるが，分割切除病変では不十分となるので，手術可能な患者のERHSEは，一括切除病変に限定するべきと考えられる。長径2cm未満の病変の一括切除率は83％（43/52）で，その初回治癒切除率は96％（50/52）と高率であり，病変内に潰瘍もしくは潰瘍瘢痕のない，長径2cm未満の分化型m癌で，占居部位が一括切除に適していれば，ERHSEによる根治切除の対象としてよいと考えられる。

Endoscopic local injection of hypertonic saline-epinephrine solution to the upper gastrointestinal bleeding: A study during the last 5-year period : Koh T, Asanuma T, Masuda K, Adachi T, Shimabukuro T, Yoshino H, Miyazaki Y, Naka H, Kawauchi H, Ueda N, Watanabe T, Hirao M. Jpn J Acute Med 1988;12:73–79

Endoscopic local injection of hypertonic saline-epinephrine solution to the upper gastrointestinal bleeding: A study during the last 5-year period : Koh T, Asanuma T, Masuda K, Adachi T, Shimabukuro T, Yoshino H, Miyazaki Y, Naka H, Kawauchi H, Ueda N, Watanabe T, Hirao M. Jpn J Acute Med 1988;12:73–79

Hemostatic effect of endoscopic local injection with hypertonic saline-epinephrine solution and pure ethanol for digestive tract bleeding

An uncontrolled study for the assessment of the hemostatic effects of endoscopically injected hypertonic saline-epinephrine (HS-E) solution and pure ethanol (PE) was carried out in 67 patients with nonvariceal gastrointestinal bleeding. The HS-E group included duodenal ulcer (18), gastric ulcer (9), gastric cancer (2), polyp (2), marginal ulcer (1), and esophageal cancer (1). Bleeding was active in 15 (pulsating, 3; oozing, 12). The hemostatic effect was permanent in 29 cases (87.9%) but failed in four cases (12.1%). The PE group consisted of 34 patients with duodenal ulcer (25), gastric ulcer (4), polyp (2), marginal ulcer (2), and gastric cancer (1). There was active bleeding in 14 (pulsating, 3; oozing, 11). The hemostatic effect was permanent in 31 cases (91.2%), temporary in 1 case (2.9%), and failed in 2 cases (5.9%). We conclude that endoscopic local injection with HS-E or PE is a simple maneuver with reasonable cost, high safety, and satisfactory hemostatic efficacy in the treatment of nonvariceal gastrointestinal bleeding.

Endoscopic local injection of hypertonic saline-epinephrine solution to arrest hemorrhage from the upper gastrointestinal tract

For the purpose of arresting hemorrhage from the upper gastrointestinal tract we developed a method of endoscopic local injection of hypertonic saline-epinephrine solution, consisting of 3.6% or 7.1% sodium chloride with 0.005% epinephrine, which was locally injected around the base of the bleeding vessel under endoscopy. During the period between October 1978 and September 1983, a total of 158 patients underwent treatment for hemostasis by this method. The major causes of bleeding in our study consisted of gastric ulcers (114) and duodenal ulcers (15). The overall effective rate of hemostasis was 98.1%. By applying this method, the rate of emergency operation for patients with bleeding from the upper gastrointestinal tract was significantly reduced from 21.7% (15/69) to 0.8% (1/128).

Clinical Study of Endoscopic Therapy for Hemorrage from Gastric Ulcer with Special Reference to Endoscopis Local Injection with Hypertonic Saline Epinephrine Solution

Clinical Study of Endoscopic Therapy for Hemorrage from Gastric Ulcer with Special Reference to Endoscopis Local Injection with Hypertonic Saline Epinephrine Solution