Impact of epinephrine volume on further bleeding due to high-risk peptic ulcer disease in the combination therapy era

作     者：Saad Saffo Anil Nagar 

作者机构：Section of Digestive DiseasesYale University School of MedicineNew HavenCT 06520United States 

出 版 物：《World Journal of Gastrointestinal Pharmacology and Therapeutics》 (世界胃肠药理与治疗学杂志（英文版）（电子版）)

年 卷 期：2022年第13卷第5期

页      面：67-76页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by the National Institutes of Health No. T32 2T32DK007356-42 

主　　题：Peptic ulcer disease Gastrointestinal bleeding Upper endoscopy Endoscopic hemostasis Epinephrine 

摘      要：BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in ***,the impact of epinephrine volume in patients treated with combination endoscopic therapy remains *** To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or *** Data from 132 patients with Forrest class Ia,Ib,and IIa peptic ulcers were *** primary outcome was further bleeding at 7 d;secondary outcomes included further bleeding at 30 d,need for additional therapeutic interventions,post-endoscopy blood transfusions,and 30-day *** and linear regression and Cox proportional hazards analyses were *** There was no association between epinephrine volume and all primary and secondary outcomes in multivariable *** odds for further bleeding at 7 d occurred in patients with elevated creatinine values(aOR 1.96,95%CI 1.30-3.20;P0.01)or hypotension requiring vasopressors(aOR 6.34,95%CI 1.87-25.52;P0.01).Both factors were also associated with all secondary *** Epinephrine maintains an important role in the management of bleeding ulcers,but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic *** bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of ***,in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable,it is conceivable that increased volumes of epinephrine may still be beneficial.