Wang Jingsong, Yu Lintao, Liu Linlin, Luo Yixing, Lv Nonghua, Shu Xu, Zhu Zhenhua
Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, P. R. China.
Sci Rep. 2025 Apr 14;15(1):12763. doi: 10.1038/s41598-025-97705-w.
Currently, there is no clear indication in the guidelines whether non-epinephrine injection monotherapy requires the addition of epinephrine for hemostasis.The purpose of this study is to compare the hemostatic efficacy of non-epinephrine injection monotherapy with combination therapy including extra epinephrine injection for peptic ulcer bleeding (PUB) patients . We retrospectively analyzed PUB patients who underwent endoscopic non-epinephrine injection as a monotherapy or combined non-epinephrine injection with epinephrine injection treatment in our center from March 2014 to January 2023 and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis. A total of 548 eligible patients were included in this study. After PSM, for PUB patients with nonbleeding visible vessels(FIIa), the recurrent bleeding rates by Days 3, 7, 14, and 30 after PSM were 17.6%, 26.5%, 27.9%, and 27.9% in the MT group, respectively, and rates were 1.4%, 5.6%, 6.9%, and 6.9% in the CT group, respectively, with significant differences observed between the 2 groups (P = 0.001, P = 0.001, P = 0.001 and P = 0.001, respectively).However, for PUB patients with spurting bleeding, oozing bleeding, and adherent clots, there were no significant differences between the two groups. For PUB patients with spurting bleeding(FIa) and oozing bleeding (FIb) ulcers, non-epinephrine injection monotherapy and epinephrine injection combined therapy have similar hemostatic efficacy. However, for PUB patients with visible blood vessel (FIIa) ulcers, combined therapy has higher hemostatic efficacy than non-epinephrine injection monotherapy.
目前，指南中尚无明确指示非肾上腺素注射单药治疗是否需要加用肾上腺素进行止血。本研究的目的是比较非肾上腺素注射单药治疗与联合肾上腺素注射治疗对消化性溃疡出血（PUB）患者的止血效果。我们回顾性分析了2014年3月至2023年1月在本中心接受内镜下非肾上腺素注射单药治疗或非肾上腺素注射联合肾上腺素注射治疗的PUB患者，并将患者分为MT组或CT组。随后，进行倾向评分匹配分析（PSM），并通过分层分析根据福里斯特分类计算再出血率。本研究共纳入548例符合条件的患者。PSM后，对于无出血可见血管（FIIa）的PUB患者，MT组在PSM后第3、7、14和30天的再出血率分别为17.6%、26.5%、27.9%和27.9%，CT组分别为1.4%、5.6%、6.9%和6.9%，两组间差异有统计学意义（P分别为0.001、0.001、0.001和0.001）。然而，对于有喷射性出血、渗血和附着血凝块的PUB患者，两组间无显著差异。对于有喷射性出血（FIa）和渗血（FIb）溃疡的PUB患者，非肾上腺素注射单药治疗和肾上腺素注射联合治疗具有相似的止血效果。然而，对于有可见血管（FIIa）溃疡的PUB患者，联合治疗的止血效果高于非肾上腺素注射单药治疗。
