Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: A prospective and randomized trial☆,☆☆,★,★★,♢
Section snippets
Inclusion criteria
From February 1990 to July 1991, a total of 495 patients were admitted to our hospital because of upper gastrointestinal hemorrhage diagnosed when melena and/or hematemesis were confirmed by the hospital staff. All patients underwent emergency upper gastrointestinal tract endoscopy. Those in whom endoscopy disclosed a peptic ulcer with active arterial bleeding or a non-bleeding visible vessel were included in the study. Only patients under 18 years of age and those unable or unwilling to give
Characteristics of patients
A total of 104 patients fulfilled the entry criteria and were consecutively included into the study and randomized. Fifty-two patients were placed in each group. Both groups were comparable in regard to age, sex, presence of associated disease, intake of NSAIDs, hemoglobin level at admission, location of ulcers, and type of bleeding (Table 1, Table 2).
In group A a second elective endoscopy was carried out in 49 patients. In the remaining 3 cases endoscopy could not be performed because of
DISCUSSION
Further hemorrhage is the single most important factor determining the outcome of patients with a bleeding ulcer.23 Endoscopic stigmata of recent hemorrhage provide prognostic information that enables identification of patients with active arterial bleeding and those with non-bleeding visible vessels who are at risk for further hemorrhage.24, 25, 26, 27, 28 The present study was performed in a group of consecutively admitted patients with bleeding peptic ulcers at high risk for further
Acknowledgements
The authors wish to thank the nursing and medical staff of the Gastrointestinal Bleeding Unit of the Hospital de la Santa Creu i Sant Pau for their cooperation in this study.
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Cited by (100)
Could immediate second-look endoscopy reduce post-endoscopic submucosal dissection bleeding?
2023, Arab Journal of GastroenterologyAcute upper gastrointestinal bleeding: A review
2020, Surgery in Practice and ScienceEffect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial
2018, Gastrointestinal EndoscopySecond look endoscopy in acute non-variceal upper gastrointestinal bleeding
2013, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :The aim of this surveillance is to pick up persistent stigmata of recent hemorrhage and commence another round of treatment to prevent rebleeding [17]. Controversies abound upon the effectiveness of second look endoscopy in preventing peptic ulcer rebleeding [18–23]. Villanueva et al reported that patients receiving second look endoscopy had 7% absolute risk reduction in rebleeding when compared to control(no routine scheduled second look endoscopy), though this did not reach statistical significance (95% CI 1.3–11.1) [18].
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From the Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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0016-5107/94/4001-0034$1.00 + .10
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GASTROINTESTINAL ENDOSCOPY
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Reprint requests: Joaquim Balanzó, Servei de Patologia Digestiva, Hospital de la Santa Creu i Sant Pau, Avgda Sant Antoni Ma Claret, 167, 08025, Barcelona, Spain.
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