Need for Second-Look Endoscopy with an Acute Peptic Ulcer Bleed

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A meta-analysis to evaluate the usefulness of routine second-look endoscopy in patients with acute upper GI bleed because of peptic ulcer disease (PUD), with evidence of hemostasis was carried out. Several databases from inception to September 15, 2020 were evaluated to identify randomized controlled trials (RCTs) that compared routine secondlook endoscopy with no planned second-look endoscopy in patients with upper GI bleed from PUD.

The outcomes of interest included recurrent bleeding, mortality, need for surgery, and mean number of units of blood transfused. For categorical variables, pooled risk ratios were calculated (RRs), with 95% confidence intervals (CIs). For continuous variables, standardized mean difference was calculated with 95% CIs. Data was analyzed using a random effects model: the grading of recommendations, assessment, development and evaluation (GRADE) framework to ascertain the quality of the evidence. 

Nine RCTs were included, comprising 1452 patients; 726 patients underwent planned routine second-look endoscopy and 726 did not. There was no significant difference in recurrent bleeding, need for surgery, mortality or mean number of units of blood transfused.  Quality of evidence ranged from low to moderate, based on the GRADE framework.

It was concluded that single endoscopy with complete endoscopic hemostasis is not inferior to routine second-look endoscopy in reducing the risk of recurrent bleeding, mortality, or need for surgery in patients with acute upper GI bleed from PUD. 

Kamal, F., Han, N., Lee-Smith, W., et al. “Role of Routine Second-Look Endoscopy in Patients With Acute Peptic Ulcer Bleeding: Meta-Analysis of Randomized Controlled Trials.” Gastrointestinal Endoscopy 2021; Vol. 93, pp. 1228-1237.

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