EUS-guided targeted epinephrine injection and immediate intraoperative bleeding during endoscopic mucosal resection: a retrospective cohort study (with video)
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective To investigate whether endoscopic ultrasound (EUS)-guided targeted epinephrine injection is associated with a lower rate of bleeding during endoscopic mucosal resection (EMR). Methods This retrospective cohort study enrolled consecutive patients undergoing EMR for gastrointestinal lesions ≥1 cm with an EUS-detectable feeding vessel at Zhengzhou Central Hospital between January 2025 and March 2026. Patients were non-randomly assigned to EUS-guided targeted epinephrine injection (1:20,000) or EUS assessment followed by conventional submucosal saline injection. The primary outcome was immediate intraoperative bleeding; secondary outcomes included delayed bleeding, procedure time, hospital stay, en bloc resection rate, and adverse events. Multivariable logistic regression was performed, with Firth regression and propensity-score (PSM and IPTW) sensitivity analyses to address confounding. Results Among 84 patients (injection group, n = 31; control group, n = 53), immediate intraoperative bleeding occurred in 0% versus 24.5% ( P = 0.002). Two delayed bleeding cases (3.8%) occurred in the control group only. No between-group differences were observed in procedure time, hospital stay, or adverse events; the en bloc resection rate was 100% in both groups. EUS-guided targeted epinephrine injection was associated with reduced odds of intraoperative bleeding (OR = 0.112, 95% CI 0.028–0.443, P = 0.002), consistent across Firth regression, PSM, and IPTW analyses. Conclusion EUS-guided targeted epinephrine injection was associated with lower immediate intraoperative bleeding during EMR without prolonging procedure time or hospital stay. These hypothesis-generating findings require confirmation in prospective randomized studies.
Source: Frontiers in Medicine
Institutions: Zhengzhou University, Zhengzhou Central Hospital
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222923618