OPTIMAL EPINEPHRINE INJECTION VOLUME FOR ENDOSCOPIC TREATMENT OF ACUTE PEPTIC ULCER BLEEDING. A SYSTEMATIC REVIEW AND META-ANALYSIS.
Bibliographic record
Abstract
Artificial intelligence: The authors declare that they did not use artificial intelligence (AI) or any AI-assisted technologies in the elaboration of the article. Lay summaryPeptic ulcers can sometimes bleed suddenly and severely, and this can be lifethreatening.Doctors often stop this bleeding using an endoscope, a small camera that allows treatment from inside the stomach.One of the most common treatments is injecting a medicine called epinephrine directly into the ulcer to help stop the bleeding.However, it has not been clear how much epinephrine should be injected for the best and safest results.In this study, we reviewed all high-quality clinical trials that compared different amounts of epinephrine injection for treating bleeding ulcers.Data from four studies involving 556 patients were analyzed.We found that using larger volumes of epinephrine was more effective at stopping the bleeding permanently than using smaller volumes.However, patients who received larger injections also had more side effects, mostly abdominal pain.Serious complications were rare but occurred only when very high volumes (more than 35 cc) were used.Overall, injecting up to 30 cc of epinephrine appears to be both safe and more effective than using smaller amounts for this type of bleeding.More research is needed to determine the best volume when epinephrine is used together with other endoscopic treatments. ABSTRACT Introduction: endoscopic treatment improves the outcomes of patients with acute peptic ulcer bleeding (APUB). Epinephrine injection is a frequently used treatment.There is no consensus, however, on the optimal volume of epinephrine injection.The primary aim of this study was to compare the efficacy and safety of endoscopic injection using different volumes of epinephrine for APUB treatment in a systematic review and meta-analysis.Methods: systematic searches were performed for full articles published from 1986 until January 2025 in multiple databases.We included randomized controlled trials (RCT) comparing different epinephrine volumes injection.Primary outcome was permanent hemostasis defined as achieved initial hemostasis and not rebleeding during admission.Secondary outcomes were adverse events (AE), need for rescue treatment and mortality.We estimated the odds ratio (OR) and 95 % confidence interval (CI) using random-effects models.Results: four RCT including 556 patients were analyzed and no studies comparing different doses of epinephrine in combination therapy were found.In studies comparing different doses of epinephrine alone, permanent hemostasis was more frequently achieved in the large-volume injection groups (91 % vs 77 %, OR: 2.90; 95 % CI: 1.72-4.86,p < 0.0001).AE were also more frequent in the large-volume groups (33 % vs 3 %, OR: 21.02; 95 % CI: 6.51-67.87,p < 0.0001).Abdominal pain was the most frequent AE.Bowel perforation appeared only when injection volumes exceeded 35 cc.Conclusion: endoscopic injection of large volumes of epinephrine up to 30 cc appear safe and improve rates of permanent hemostasis when compared to lower injection volume in patients with APUB.Trials assessing the use of larger epinephrine volume in combination endoscopic hemostatic therapy are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.034 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".