Effect of scheduled second therapeutic endoscopy on ulcer rebleeding

A scheduled repeat endoscopy, with appropriate therapy, between 16 and 24 hours after initial endoscopic hemostasis reduces incidents of recurrent peptic ulcer bleeding, report physicians in the October issue of Gut.

Recurrent bleeding after initial hemostasis is important in the management of peptic ulcer bleeding. However, there have been conflicting reports on the effectiveness of a scheduled second therapeutic endoscopy in ulcer rebleeding.

In this study, a team of physicians from Hong Kong, China, investigated the use of scheduled second endoscopy with appropriate therapy on peptic ulcer rebleeding.

The team randomized 194 patients, with endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel, or adherent clot, into 2 groups.

The study group received a scheduled second endoscopy, between 16 and 24 hours after initial hemostasis. Further therapy of an initial epinephrine injection and subsequent heater probe application was applied if endoscopic stigmata persisted.

The control group was observed closely.

Recurrent bleeding: - control group = 14% - study group = 5%

Gut

Any patients who developed rebleeding underwent operation, once further endoscopic therapy failed.

The research team measured ulcer rebleeding, transfusion, duration of hospital stay, and mortality.

The team found that 14% of patients in the control group developed recurrent bleeding within 30 days, compared with 5% in the study group. In addition, 6 patients in the control group required surgery for recurrent bleeding, compared with 1 in the study group.

The physicians did not identify any difference in the duration of hospital stay, transfusion, or mortality between the 2 groups.

Dr Chin's team concluded, "A scheduled repeat endoscopy with appropriate therapy 16 to 24 hours after initial endoscopic hemostasis reduces the number of cases of recurrent bleeding".