Investigation of cardiac side effects of endoscopic submucosal adrenaline injection

Introduction: Endoscopy is a procedure that is used frequently and for very different purposes from diagnosis to treatment. Adrenaline is injected into the submucosa in different doses and titers during gastrointestinal system bleeding, polypectomies, endoscopic mucosal resection and endoscopic submucosal dissection, since adrenaline is effective in providing hemostasis and is easy to use. However, there are not enough studies in the literature regarding the cardiac effects of this application. The aim of this thesis is to investigate the cardiac safety of adrenaline injection to the gastrointestinal tract submucosa, which has been routinely applied in clinical practice for years. Material and Method: This study was conducted prospectively with patients over 18 years of age who underwent endoscopy between August 2019 - February 2020 in Düzce University Health Application and Research Center Gastroenterology Department. A total of 146 patients were included in the study, including patients who were administered adrenaline at 1:1000, 1:10.000 and 1:20.000 titers, and the control group without adrenaline. Pulse (beats/minute), systolic and diastolic blood pressure (mmHg) were measured and recorded at the 0th, 3rd, 6th, 9th and 12th minutes after injection to investigate the systemic effects of adrenaline given with varying concentrations during the procedures. This study was carried out in accordance with the principles of the Declaration of Helsinki by obtaining permission from the Düzce University Ethics Committee, dated 05.08.2019, decision number 2019/162. Results: The groups were homogeneous in terms of gender, age, presence of comorbid diseases, use of beta blockers, use of calcium channel blockers and use of other anti-hypertensive drugs. When systolic, diastolic blood pressure and pulse data were examined, there was no significant increase in systolic blood pressure, diastolic blood pressure and heart rate parameters due to adrenaline, in four arms of the study, representing different titers of adrenaline. However, when each group was examined within itself, it was found that there was a significant increase in diastolic blood pressure and heart rate over time, but no increase was observed in systolic blood pressure. Conclusion: Our study suggests that adrenaline is cardiovascularly safe when it is necessary to exceed the dose and titers applied in daily clinical practice. We believe that our study will shed light on randomized controlled studies to be conducted with a higher number of patients. Keywords: Adrenaline, endoscopy, gastrointestinal hemorrhage, blood pressure, pulse