Shorter fast after endoscopic hemostasis may not cause more ulcer rebleeds

Last Updated: 2020-03-31

By Reuters Staff

NEW YORK (Reuters Health) - Refeeding at 24 hours after endoscopic hemostasis for peptic ulcer bleeding appears no worse than refeeding at 48 hours in terms of rebleeding in high-risk patients, a new single-center randomized trial shows.

"Our results do not allow a recommendation of early refeeding at 24 hours rather than later refeeding in this population," Dr. Eun Jeong Gong of Gangneung Asan Hospital, in Gangneung, South Korea, and colleagues conclude in the American Journal of Gastroenterology.

Studies to date suggest that earlier feeding does not increase the risk of recurrent bleeding in non-high-risk ulcer patients, Dr. Gong and colleagues note, and their own research in gastric-cancer patients found early feeding was associated with reduced hospital stay and greater satisfaction, without increased bleeding, after endoscopic submucosal dissection.

"However, the feeding strategies are not based on concrete evidence, and it remains unclear whether the reintroduction of feeding should be delayed to prevent recurrent bleeding in patients with high-risk peptic ulcer bleeding," they write.

To investigate, the team randomized 209 consecutive patients with peptic-ulcer bleeding treated successfully with endoscopic hemostasis to begin feeding at 24 or 48 hours after the procedure. They set the non-inferiority margin at 10 percentage points - a margin that some may consider too large, they note.

In the per-protocol analysis of 200 patients, at seven days, 7.9% of the 24-hour group and 4.0% of the 48-hour group had rebleeding (P for noninferiority=0.034).

Within 30 days, rebleeding occurred in 10.9% and 4.0%, respectively, while 30-day mortality was 5.9% and 14.1%. Both differences bordered on statistical significance.

Each group had a median of 2.2 blood units transfused, and median length of stay was not significantly different, at 7.2 days for the 24-hour group and 6.6 days for the 48-hour group.

Patients received the diet in a stepped fashion that required them to spend at least four days in the hospital after hemostasis, Dr. Gong and colleagues note, which is longer than guidelines recommend.

They conclude: "Studies with a larger sample size are warranted to clearly demonstrate the optimal timing of feeding in patients with high-risk peptic ulcer bleeding."

SOURCE: https://bit.ly/2JnTiRp American Journal of Gastroenterology, online March 20, 2020.