ENDOSCOPIC INTERVENTIONAL MANAGEMENT USING ADRENALINE-NORMAL SALINE INJECTION FOR ACTIVELY BLEEDING PEPTIC ULCERS IN SOUTH KASHMIR, INDIA

Aim:TodeterminetheefficacyofendoscopicNormalSalineAdrenaline(NSA)injectiontherapyinactivelybleedingpepticulcerdiseasepatientsof southernKashmir.

Methods: All those patients who presented with upper GI bleed (UGB) malena/hematemesis or both underwent early upper GI endoscopy after stabilization. Those patients who had actively bleeding peptic ulcers(gastric/duodenal) were enrolled in this study. They were injected 10-15ml of 1:10000 adrenaline diluted in normal saline around the 3mm of bleeding ulcer, including ulcer base. Modified Forrest classification was used for assessment and management purposes. Patients with variceal bleed were excluded from the study.

Results:There were 136 actively bleedingPepticUlcerpatients (84 males,52females)intheagegroupof18-65years.96(70.58%)patients had duodenal Ulcer(DU), whereas40(29.42%) patients hadGastricUlcer(GU). Primaryhemostasis was achieved in 98.53% of patients with endoscopic injection therapy. One patient who was an elderly male withForrestIA duodenal ulcerunderwent emergency gastrojejunostomybecauseof underlyinglargevesselhemorrhage,whichcouldnotbecontrolledbythe endoscopic obliteration method. Another patient with Forrest IB, who failed with obliteration twice, responded to endoscopic clipping. Rebleeding was observed in 12 (8.82%) patients. There was no mortality in this study.

Conclusion: Endoscopic injection therapy is a simple, cheap, safe, and highly effective first-line treatment for a non-variceal upper GI bleed procedure. It avoids urgent emergency surgical interventions and related complications, thus reducing these patients mortality and morbidity.