EUS-guided targeted epinephrine injection and immediate intraoperative bleeding during endoscopic mucosal resection: a retrospective cohort study (with video)
- 1Department of Gastroenterology, Zhengzhou Central Hospital Affiliated to Zhengzhou University , , ,
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.
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BibTeX
@article{wang2026eusguided,
title = {{EUS-guided targeted epinephrine injection and immediate intraoperative bleeding during endoscopic mucosal resection: a retrospective cohort study (with video)}},
author = {Wanting Wang and Aimei Rong and Chan Liao and Hongli Chen and Jiaqi Han and Qianping Liang},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1985945},
url = {https://europepmc.org/article/PMC/PMC13724387},
note = {CC BY},
}
RIS
TY - JOUR
TI - EUS-guided targeted epinephrine injection and immediate intraoperative bleeding during endoscopic mucosal resection: a retrospective cohort study (with video)
AU - Wanting Wang
AU - Aimei Rong
AU - Chan Liao
AU - Hongli Chen
AU - Jiaqi Han
AU - Qianping Liang
PY - 2026
DA - 2026/10/19
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1985945
UR - https://europepmc.org/article/PMC/PMC13724387
AB - 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.
SN - 2296-858X
ER -