Non-epinephrine monotherapy matches combination therapy in high-risk PUB patients

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.