Treating delayed endoscopic sphincterotomy-induced bleeding: Epinephrine injection with or without thermotherapy

Yung Kuan Tsou, Cheng Hui Lin, Nai Jen Liu, Jui Hsiang Tang, Kai Feng Sung, Chi Liang Cheng, Ching Song Lee

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


AIM: To compare the hemostatic efficacy between epinephrine injection alone and epinephrine injection combined with thermotherapy for delayed postendoscopic sphincterotomy (ES) bleeding. METHODS: Cases with delayed post-ES bleeding undergoing epinephrine injection alone (epinephrine injection group, n = 26) or epinephrine combined with thermotherapy (combination therapy group, n = 33) in our institution between 1999 and 2007 were retrospectively investigated. The main outcome measurements were: initial endoscopic hemostasis, rebleeding, complications, requirement of angiographic embolization or surgery, requirement for blood transfusion, and mortality. RESULTS: The initial hemostatic efficacy was 96.2% for epinephrine injection alone and 100% for combination therapy (P = 0.44). There were four patients with re-bleeding in each group (16.0% vs 12.1%, P = 0.72). There was only one complication of pancreatitis from the combination therapy group. Three patients (11.5%) in the epinephrine injection group and one patient (3%) in the combination therapy group required angiographic embolization or surgery (P = 0.31). The total number of blood transfusions was not significantly different between the two groups (3.5 ± 4.6 U vs 3.5 ± 4.5 U, P = 0.94). There was no bleeding-related death in either group. CONCLUSION: Epinephrine injection alone is as effective as epinephrine injection combined with thermotherapy for the management of delayed post-ES bleeding.

Original languageEnglish
Pages (from-to)4823-4828
Number of pages6
JournalWorld Journal of Gastroenterology
Issue number38
Publication statusPublished - 2009
Externally publishedYes


  • Bleeding
  • Endoscopic retrograde cholangiopancreatography
  • Endoscopic sphincterotomy
  • Epinephrine
  • Thermotherapy

ASJC Scopus subject areas

  • Gastroenterology


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