Is routine second-look endoscopy effective after endoscopic hemostasis in acute peptic ulcer bleeding? A meta-analysis

Risk Factors for Rebleeding in Peptic Ulcer Bleeding: A Second Look at Second-Look Endoscopy

“…A Cochrane analysis reported that combination of epinephrine injection with a second endoscopic treatment modality reduces the relative risk (RR) of rebleeding or persistent bleeding (RR 0.57) compared to endoscopic treatment with epinephrine alone [5]. Therefore, endoscopic monotherapy with injection of epinephrine should be avoided.In a meta-analysis based on eight randomized controlled trials (RCTs) published from 1994 to 2006, performance of second-look endoscopy within 16-48 h was associated with a significant reduction in rebleeding rate (OR 0.55) [6]. Generalization of this finding to current practice standards can be questioned because only one of the included studies used endoscopic combination therapy combined with high-dose infusion of proton-pump inhibitors [7].…”

“…Furthermore, detailed review of the fully published component studies revealed that a significant reduction in rebleeding was only evident in two studies that included patients with a very high risk of rebleeding (up to 47 % of included patients had hemodynamic shock) [6]. When these two trials were excluded from the meta-analysis, the association between performance of second-look endoscopy and rebleeding became statistically insignificant [6]. In a cost-effectiveness analysis, performance of secondlook endoscopy was only cost-effective after therapeutic endoscopy if the risk of rebleeding was greater than 31 % [8].…”

“…In a meta-analysis based on eight randomized controlled trials (RCTs) published from 1994 to 2006, performance of second-look endoscopy within 16-48 h was associated with a significant reduction in rebleeding rate (OR 0.55) [6]. Generalization of this finding to current practice standards can be questioned because only one of the included studies used endoscopic combination therapy combined with high-dose infusion of proton-pump inhibitors [7].…”

“…Generalization of this finding to current practice standards can be questioned because only one of the included studies used endoscopic combination therapy combined with high-dose infusion of proton-pump inhibitors [7]. Furthermore, detailed review of the fully published component studies revealed that a significant reduction in rebleeding was only evident in two studies that included patients with a very high risk of rebleeding (up to 47 % of included patients had hemodynamic shock) [6]. When these two trials were excluded from the meta-analysis, the association between performance of second-look endoscopy and rebleeding became statistically insignificant [6].…”

Second-Look Endoscopy After ESD: Can We Finally See the Forrest from the Trees?

“…The Forrest classification (Table 1) is a valid tool for describing and predicting acute peptic ulcer lesions that are at high risk of re-bleeding. A recent meta-analysis of patients with acute peptic ulcer bleeding reported the effectiveness of SLE in reducing delayed bleeding (OR 0.55; 95 % CI 0.37-0.81) [5]. Nonetheless, the only included trial in which high-dose proton pump inhibitors (PPIs) were used did not support any benefit of SLE.…”