The agents available for injection therapy include the following: (1) epinephrine, (2) sclerosants (polidocanol, ethanolamine, cyanoacrylate, sodium tetradecyl, and absolute ethanol), and (3) clot-inducing substances (thrombin and fibrin glue).
Injection therapy initiates hemostasis by any of several mechanisms depending on the agent used. Although epi-nephrine causes vasoconstriction and alters platelet function, local tissue tamponade is probably the most important contributor to its hemostatic effect. Sclerosants such as polidocanol cause tissue necrosis, secondary inflammation, and venous and arterial thrombosis. Absolute ethanol causes profound tissue dehydration, secondary inflammation, and necrosis. Clot-inducing substances induce thrombosis without tissue injury.
A meta-analysis of trials of patients with high risk bleeding ulcers confirmed the effectiveness of injection therapy by showing significant reductions in recurrent bleeding and emergency surgery rates (Cook et al, 1992) Reduced mortality was not shown with injection therapy alone but did exist with combination therapy (discussed below).
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