Scheduled second-look endoscopy does not reduce peptic ulcer rebleeding rates

Last Updated: 2017-07-28

By Reuters Staff

NEW YORK (Reuters Health) - Peptic ulcer rebleeding rates do not differ significantly between patients who undergo a single endoscopy with hemostasis versus those who undergo a scheduled second-look endoscopy, South Korean researchers report.

Endoscopic therapy is widely used for treating patients with high-risk bleeding peptic ulcers, but upwards of 15% of patients develop recurrent bleeding after initial endoscopic hemostasis. Some have proposed a scheduled second-look endoscopy with appropriate therapy where necessary to reduce the risk of recurrent bleeding, but studies have yielded inconsistent results.

Dr. Hyojin Park and Dr. Yong Chan Lee from Yonsei University College of Medicine in Seoul and colleagues from seven hospitals investigated the effect of scheduled second endoscopy with appropriate therapy, compared with close observation after the initial endoscopy, in a randomized trial of 319 patients who presented with bleeding peptic ulcers.

During the first week after initial hemostasis, 9.4% of patients in the second-look endoscopy group developed rebleeding, compared with 4.9% of patients in the control group (p=0.118), the researchers report in Gastrointestinal Endoscopy, online July 20.

Similarly, within 30 days after the initial endoscopy, the rate of rebleeding did not differ significantly between the control group (5.6%) and the second-look endoscopy group (10.1%, p=0.132).

The groups did not differ either in the numbers of radiologic interventions for rebleeding, operations to salvage rebleeding, mean number of units of blood transfused, median durations of hospital stay, or mortality.

Independent predictors of rebleeding included unsatisfactory initial endoscopic hemostasis in the endoscopist's estimation, use of NSAIDs and larger amounts of transfused blood.

The researchers conclude that "a single endoscopy with complete endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate on bleeding peptic ulcer. Second-look endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis measured by expert endoscopists, concomitant NSAID usages, and larger amounts of transfused blood."

Dr. Park and Dr. Lee did not respond to a request for comment.

SOURCE: http://bit.ly/2h80uGk

Gastrointest Endosc 2017.