What is the role of injection therapy in the treatment of upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Injection therapy involves the use of several different solutions injected into and around the bleeding lesion. Solutions available for injection include epinephrine, sclerosants, and various clot-producing materials, such as fibrin and cyanoacrylate glues.

The epinephrine used for injection is diluted (1:10,000) and injected as 0.5- to 1-mL aliquots. Debate continues over whether the hemostatic effect of epinephrine is due to induced vessel vasoconstriction and subsequent platelet aggregation or to the tamponade effect produced by injecting the volume of drug into the tissue surrounding the bleeding lesion.

Epinephrine injection is often used to reduce the volume of bleeding so that the lesion can be better localized and then treated with a coaptive technique (ie, heater probe, gold probe).

Combining epinephrine injections with human thrombin (600-1000 IU) reduces the risk of bleeding. [6]

Although the epinephrine administered in injection therapy is absorbed into the systemic circulation, this does not appear to have any adverse effects on the hemodynamic status.

Injecting a volume of sterile isotonic sodium chloride solution and providing a tamponade effect also leads to hemostasis, although not as effectively as does epinephrine. [6]

The sclerosant solutions such as ethanol, polidocanol, and sodium tetradecyl sulfate are not frequently administered relative to the use of other available techniques for hemostasis in nonvariceal GI bleeding. Band ligation of esophageal varices is currently used more commonly than sclerosants.

The sclerosants create hemostasis by inducing thrombosis, tissue necrosis, and inflammation at the site of injection. When large volumes are injected, the area of tissue necrosis can produce an increased risk of local complications, such as perforation. [109] Combining the various agents into a single injection has not been shown to be more beneficial than a single-agent therapy alone. [6]

The use of fibrin glue in injection therapy has been shown to be successful, with results similar to those of epinephrine injections. [110]

Cyanoacrylate is effective in achieving hemostasis, with success rates similar to that of hemoclips. [111, 112]


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