Effect of Programmed Endoscopic Follow-up Examinations on the Rebleeding Rate of Gastric or Duodenal Peptic Ulcers Treated by Injection Therapy: A Prospective, Randomized Controlled Trial

Messmann, Helmut; Schaller, Peter; Andus, T.; Lock, Guntram; Vogt, W.; Gross, V.; Zirngibl, Hubert; Wiedmann, K. H.; Lingenfelser, Thomas; Bauch, K; Leser, H. G.; Schölmerich, J.; Holstege, Axel

doi:10.1055/s-2007-1001360

Cited by 97 publications

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“…First, an extremely high proportion of active bleeders (70%) were enrolled, which makes it difficult to generalize the results to the average patient with bleeding peptic ulcer disease. Persistent high risk stigmata led to retreatment in 84% of the patients, which is a much higher proportion than in most other studies (19% to 59%) (13,16,17). Third, there was no case of early (within 24 h) rebleeding.…”

Section: Why Consider a Routine Second Look?mentioning

confidence: 61%

“…Third, there was no case of early (within 24 h) rebleeding. In most other studies, approximately 20% of patients had already experienced rebleeding before the second endoscopy at 24 h (13,16). Fourth, 40% of rebleeding episodes occurred extremely late (more than 72 h after initial endoscopy), at six and 10 days, respectively.…”

Section: Why Consider a Routine Second Look?mentioning

confidence: 88%

“…There have been six randomized trials of second look endoscopy (13)(14)(15)(16)(17)(18), including two that were published in abstract form only. Of these studies, four (Table 1) showed that a routine second look endoscopy is not effective for reducing rebleeding rates or other adverse outcomes (13,15,16,18).…”

Section: Why Consider a Routine Second Look?mentioning

confidence: 99%

“…Of these studies, four (Table 1) showed that a routine second look endoscopy is not effective for reducing rebleeding rates or other adverse outcomes (13,15,16,18). One of the two positive studies was published only in abstract form several years ago (17).…”

Section: Why Consider a Routine Second Look?mentioning

confidence: 99%

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Routine Second-Look Endoscopy: Ineffective, Costly, and Potentially Misleading

Romagnuolo¹

2004

Canadian Journal of Gastroenterology

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J Romagnuolo. Routine second look endoscopy: Ineffective, costly and potentially misleading. Can J Gastroenterol 2004;18(6):401-404.Despite the best medical and endoscopic efforts, some patients with nonvariceal upper gastrointestinal bleeding suffer recurrences. Because high risk stigmata (visible vessels, active bleeders and adherent clots) often persist despite apparently successful initial hemostasis and have a variable natural history, it would seem reasonable to at least consider a routine second look endoscopy. However, a review of the literature revealed six randomized trials that, in aggregate, do not support such a strategy. In fact, a second look does not appear to be effective and is associated with an increased number of procedures, treatment sessions and possibly retreatment-related complications. In addition, the cointerventions in these trials are already out of date and the potential absolute risk reductions are low when a second look is used with intravenous proton pump inhibitors and/or the application of endoscopic hemoclips or combination endoscopic therapy. Finally, the Forrest classification may provide dangerously misleading estimates of prognosis because it is being used out of context. This review critically analyzes routine second look endoscopy.Key Words: Endoscopic therapy; Gastroscopy; Nonvariceal upper gastrointestinal bleeding; Peptic ulcer disease Une endoscopie de contrôle systématique : inefficace, coûteuse et peut-être trompeuse Malgré les plus grands efforts médicaux et endoscopiques, certains patients souffrant d'hémorragie gastro-intestinale non variqueuse présen-tent des récurrences. Parce que des stigmates à haut risque (vaisseaux visibles, saignées actives et caillots d'adhérence) subsistent souvent malgré une hémostase initiale en apparence réussie et qu'ils ont des antécédents naturels variables, il semblerait raisonnable d'au moins envisager une endoscopie de contrôle systématique. Cependant, une analyse bibliographique révèle que six essais aléatoires n'appuient pas, dans l'ensemble, une telle stratégie. En fait, un contrôle ne semble pas être efficace et s'associe à un plus grand nombre d'interventions, de séances de traitement et, peut-être, de complications reliées au deuxième traitement. En outre, les co-interventions utilisées dans ces essais sont déjà dépassées, et les réduc-tions absolues et potentielles du risque sont faibles lorsque ces interventions sont les inhibiteurs de la pompe à proton par voie intraveineuse ou l'application de pinces hémostatiques endoscopiques. Enfin, la classification de Forrest comporte peut-être des évaluations dangereusement trompeuses du pronostic parce qu'elle est utilisée hors contexte. La présente analyse évalue l'endoscopie de contrôle d'un oeil critique. D espite advances in the endoscopic treatment of bleeding peptic ulcer disease, there remains a significant rebleeding rate of 10% to 20% (1,2). Adjuvant intravenous proton pump inhibitor therapy has been proven to reduce the rebleeding rate when used with successful endos...

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Section: Why Consider a Routine Second Look?mentioning

confidence: 61%

Section: Why Consider a Routine Second Look?mentioning

confidence: 88%

Section: Why Consider a Routine Second Look?mentioning

confidence: 99%

Section: Why Consider a Routine Second Look?mentioning

confidence: 99%

See 2 more Smart Citations

Routine Second-Look Endoscopy: Ineffective, Costly, and Potentially Misleading

Romagnuolo¹

2004

Canadian Journal of Gastroenterology

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“…Routine "second look" endoscopy, in the absence of established rebleeding or patient instability, has gone out of vogue after studies showed no benefit with regards to clinically significant outcomes for unselected patient populations, 65 although there may be a role in high risk patients. 66,67 Repeat therapeutic endoscopy may be indicated (depending on local endoscopic and surgical expertise) if there is clinical evidence of re-bleeding or if the initial therapeutic procedure was unsuccessful or partially successful.…”

Section: "Second-look" Endoscopy and Endoscopic Re-treatmentmentioning

confidence: 99%

Nonvariceal Upper Gastrointestinal Bleeding

Ferguson

Mitchell²

2004

Endoscopy

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A study in the Netherlands examined recent time trends in the incidence and outcome of upper gastrointestinal bleeding between the periods 1993-94 and 2000 [1]. The incidence of acute upper gastrointestinal bleeding decreased from 61.7 per 100 000 in 1993-94 to 47.7 per 100 000 persons annually in 2000, corresponding to a 23 % decrease in the incidence after age adjustment (95 % CI, 15 % to 30 %). Despite more frequent use of combination treatment, more frequent endoscopic interventions to treat ulcers with adherent clots, and a higher rate of protonpump inhibitor (PPI) use in the second period, the rebleeding rate (16 % vs. 15 %) and mortality rate (14 % vs. 13 %) did not differ between the two periods. Ulcer bleeding remained the most frequent cause of bleeding, at 40 % (1993-94) and 46 % (2000). Almost half of all patients with peptic ulcer bleeding were using nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. Re-bleeding was similarly high among patients with peptic ulcer bleeding in both groups (20 % and 22 %, respectively). Increasing age, presence of severe comorbidities, and rebleeding were associated with higher mortality. An analysis of secular trends in hospitalization and mortality rates from peptic ulcer disease, upper gastrointestinal bleeding, and any gastrointestinal bleeding was published using data from the National Hospital Discharge Survey [2]. These rates were compared with sales of NSAIDs, aspirin, and acid-suppression medications from 1992 to 1999. Annual rates of hospitalization and mortality per 100 000 population for peptic ulcer disease declined from 205 to 165 and 7.7 to 6.0, respectively; the calendar year correlated negatively with both peptic ulcer disease hospitalization rates (P = 0.007) and mortality rates (P = 0.058). Sales of acid-suppression medications correlated negatively with peptic ulcer disease hospitalization rates (P = 0.037) and mortal

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Gastrointestinal Bleeding

Tariq¹

Principles and Practice of Geriatric Medicine

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Effect of Programmed Endoscopic Follow-up Examinations on the Rebleeding Rate of Gastric or Duodenal Peptic Ulcers Treated by Injection Therapy: A Prospective, Randomized Controlled Trial

Cited by 97 publications

References 0 publications

Routine Second-Look Endoscopy: Ineffective, Costly, and Potentially Misleading

Routine Second-Look Endoscopy: Ineffective, Costly, and Potentially Misleading

Nonvariceal Upper Gastrointestinal Bleeding

Gastrointestinal Bleeding

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