ethanol or a simple saline solution for bleeding peptic ulcers?

Q: If an 'epi' injection is not available during endoscopy, ethanol or a simple saline solution can be used for bleeding peptic ulcers.

A) True 

B) False

Answer: A

For bleeding peptic ulcers, different modalities can be applied to stop bleeding, including thermal coagulation, endoscopic clip placement, and/or injection with diluted epinephrine.

Epi injection provides local tamponade and vasospasm and is a good way of achieving temporary hemostasis. It is applied in four quadrants within 3 mm of the bleeding site. Another less-known advantage of epi is its potential to provide a cleaner field to evaluate the bleeding site. 

Though commonly used in the past, injection of absolute ethanol can be used instead of diluted epi with relatively same efficacy.

Interestingly, saline injection has also been used but has a higher chance of recurrent bleeding.

#GI

References:

1. Koyama T, Fujimoto K, Iwakiri R, et al. Prevention of recurrent bleeding from gastric ulcer with a nonbleeding visible vessel by endoscopic injection of absolute ethanol: a prospective, controlled trial. Gastrointest Endosc 1995; 42:128.

2. Lazo MD, Andrade R, Medina MC, et al. Effect of injection sclerosis with alcohol on the rebleeding rate of gastroduodenal peptic ulcers with nonbleeding visible vessels: a prospective, controlled trial. Am J Gastroenterol 1992; 87:843.

3. Laine L, Estrada R. Randomized trial of normal saline solution injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers: is local tamponade enough? Gastrointest Endosc 2002; 55:6.