Planned second look endoscopy in patients with bleeding duodenal or gastric ulcers

Preliminary studies have suggested a beneficial effect of second look endoscopy in patients with bleeding peptic ulcers.

We have performed a retrospective survey of seventy patients with bleeding peptic ulcers admitted to our unit in the period 1 September 1996-31 March 1998. Planned second look endoscopy and repeated sclerotherapy were standard care. The effects were evaluated by comparing the expected number of rebleeders with actual rebleeders. At the same time we assessed predicting factors for rebleeding.

Fifteen of the admitted seventy patients were found to rebleed after initial sclerotherapy. The overall success rate of endoscopic therapy was 63/70 patients (90%). Six patients (9%) had to undergo surgery to obtain haemostasis, and one patient died suddenly after the second endoscopic sclerotherapy. Perforation was seen in two patients (3%) and the total mortality (30 days) was 4% (three patients). The most important factor predicting rebleeding was the occurrence of active bleeding at the initial endoscopy.

From the literature we could expect that twenty to twenty-five patients would rebleed, comparing this with the findings of the present study suggests a beneficial effect on rebleeding rate of patients treated with planned second look endoscopy. Future controlled trails should verify this hypothesis.