A novel technique of injection treatment for endoscopic sphincterotomy-induced hemorrhage

Background: We prospectively investigated the efficacy and safety of double injection of dextrose 50 % plus epinephrine (D₅₀+E) solution in endoscopic hemostasis of postendoscopic sphincterotomy (ES) hemorrhage.

Patients and methods: The study included 1331 consecutive patients who underwent 1331 ES procedures between March 2002 and June 2006. Bleeding patterns (trickle, oozing, pulsatile, none) were recorded. Patients with oozing or trickle bleeding who did not respond to spray irrigation of D₅₀+E solution and all the patients with pulsatile bleeding, received double injection of D₅₀+E solution at 2 - 3 cm proximal and into the bleeding point with a sclerotherapy needle. Risk factors for post-ES hemorrhage were also assessed.

Results: ES-induced hemorrhage occurred in 63 patients (4.73 %). Visible bleeding patterns immediately following ES were: 44 trickle (69.84 %), 13 oozing (20.63 %) and six pulsatile (9.52 %). Hemostasis was achieved by spray irrigation of solution in 41 of 44 patients (93.18 %) with trickle, and in three of 13 patients (23.07 %) with ooze bleeding. Double injection was required in all patients with pulsatile bleeding, in 10 patients (76.92 %) with oozing, and in three patients (6.82 %) with trickle bleeding. Overall, successful hemostasis was achieved with double injection in 18 of 19 patients (94.74 %). The “zipper” cut was revealed to be a sole significant risk factor to the occurrence of bleeding (P < 0.001). Five non-bleeding patients (0.37 %) presented with delayed hemorrhage. The difference in the incidence of other complications between the groups treated or not treated by endoscopic hemostasis was not statistically significant.

Conclusion: Double injection of the readily available and inexpensive D₅₀+E solution is a safe and effective treatment and is recommended for post-ES hemorrhage.

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