Reply to the letter of Matsushita et al.

We appreciate the interest of Matsushita and colleagues in our study which described a novel technique of double injection of dextrose 50 % plus epinephrine (D₅₀+E) solution in the endoscopic hemostasis of post-endoscopic sphincterotomy (ES) hemorrhage [1].

They conclude that their reported technique of a single injection of hypertonic saline plus epinephrine (1 : 10 000) solution 2 - 3 cm orad to the bleeding papilla, which was done in only two patients [2], is superior to our technique, which was done in 19 patients and failed to achieve hemostasis in one patient. However, we believe that their conclusion is quite arbitrary.

Taking into account that the incidence of severe post-ES bleeding which requires endoscopic intervention is about 1 % to 2 % [3], confirmation of the superiority of one technique over another in achieving hemostasis would require a clinical study involving a large number of patients. However, it would be difficult to carry out such a study in a single endoscopy department.

Moreover, we would like to underline that in our study the amount of D₅₀+E solution injected orad to the bleeding papilla was not 0.5 mL, but aliquots of 0.5 mL, as can be deduced from the total injected volumes of D₅₀+E solution which ranged from 3.5 mL to 14 mL (median volume 4.8 mL) [1].

Competing interests: None

References

• 1 Katsinelos P, Kountouras J, Chatzimavroudis G. et al . A novel technique of injection treatment for endoscopic sphincterotomy induced hemorrhage.  Endoscopy. 2007;  39 631-636
• 2 Matsusita M, Hajiro K, Takakuwa H. et al . Effective hemostatic injection above the bleeding site for uncontrolled bleeding after endoscopic sphincterotomy.  Gastrointest Endosc. 2000;  51 221-223
• 3 Vásconez C, Llach J, Bordas J M. et al . Injection treatment of hemorrhage induced by endoscopic sphincterotomy.  Endoscopy. 1998;  30 37-39