Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers

Gastrointest Endosc. 2006 May;63(6):767-73. doi: 10.1016/j.gie.2005.11.048.


Background: Rebleeding occurs in 10% to 30% of bleeding ulcer patients receiving endoscopic epinephrine injection therapy. It remains unclear whether addition of a secondary clip therapy following epinephrine injection may reduce the rebleeding rate of high-risk bleeding ulcers.

Objective: To compare the efficacies of epinephrine injection alone and epinephrine injection combined with hemoclip therapy in treating high-risk bleeding ulcers.

Design: Prospective randomized controlled trial.

Setting: A medical center in Taiwan.

Patients: One hundred five bleeding ulcer patients with active spurting, oozing, nonbleeding visible vessels or adherent clots in ulcer bases.

Interventions: Endoscopic combination therapy (n = 52) or diluted epinephrine injection alone (n = 53).

Main outcome measurements: Initial hemostasis rates and recurrent bleeding rates.

Results: Initial hemostasis was achieved in 51 patients treated with combination therapy and 49 patients with epinephrine injection therapy (98% vs 92%, P = .18). Bleeding recurred in 2 patients in the combination therapy group and 11 patients in the epinephrine injection group (3.8% vs 21%, P = .008). Among the patients with rebleeding, repeated combination therapy was more effective than repeated injection therapy in achieving permanent hemostasis (100% vs 33%, P = .02). No patient required an emergency operation in the combination therapy group. However, 5 patients in the epinephrine injection group underwent emergency surgery to arrest bleeding (0% vs 9%, P = .023).

Limitations: Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists.

Conclusion: Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Combined Modality Therapy
  • Duodenal Ulcer / surgery*
  • Epinephrine / administration & dosage
  • Epinephrine / therapeutic use*
  • Female
  • Hemostasis, Endoscopic / methods*
  • Humans
  • Injections
  • Length of Stay
  • Male
  • Middle Aged
  • Peptic Ulcer Hemorrhage / surgery*
  • Prospective Studies
  • Recurrence
  • Stomach Ulcer / surgery*
  • Treatment Outcome
  • Vasoconstrictor Agents / administration & dosage
  • Vasoconstrictor Agents / therapeutic use*


  • Vasoconstrictor Agents
  • Epinephrine