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Hemostatic procedure by endoscope for gastro intestinal bleeding clinical practice of endoscopic local injection of hypertonic sodium epinephrine solution



Hemostatic procedure by endoscope for gastro intestinal bleeding clinical practice of endoscopic local injection of hypertonic sodium epinephrine solution



Stomach & Intestine (Tokyo) 15(7): 751-755



To manage massive hemorrhage from the stomach and the other portions of the gastrointestinal tract, a method of endoscopic local injection HS-E [hypertonic Na epinephrine] solution was developed. HS-E solution has vasoconstrictive action of epinephrine and physiochemical property of hypertonic Na solution. Prolonged action of epinephrine by hypertonic Na and a series of organic changes which include swelling of surrounding tissue of injected site, fibrinoid degeneration of arterial wall and thrombus formation can explain the mechanism of hemostasis. Prior to emergency endoscopic examination, evaluation of systemic conditions, maintenance of venous route, insertion of gastric tube, aspiration of gastric contents and pharyngeal anesthesia must be performed. Administration of antispastics and sedatives is recommended. Concentration of Na in HS-E solution is 625-1250 meq/l and that of epinephrine 0.05 mg/ml. When the bleeding lesion in discovered through the endoscope, the exact bleeding point around which HS-E is injected at 3-4 sites with 3 ml at each site must be detected. If the procedure is effective, hemostasis is readily obtained. This procedure was used on 23 lesions of 21 cases; permanent hemostasis was obtained on 19 lesions (82.6%). Endoscopic local injection of HS-E solution is particularly effective to manage bleeding from stomal ulcers, stress ulcers and Mallory-Weiss syndrome.

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Accession: 005559375

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