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Second look endoscopy in acute non-variceal upper gastrointestinal bleeding
1Institute of Digestive Disease, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong SAR, China.
Best Practice & Research. Clinical Gastroenterology
|November 5, 2013
Summary
Routine second look endoscopy for bleeding peptic ulcers reduces rebleeding, but selective approaches are more cost-effective. Further research should identify high-risk patients for targeted interventions.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
Background:
- Bleeding peptic ulcers are a significant cause of hospitalization globally.
- Initial endoscopic hemostasis is successful in over 90% of cases, but rebleeding occurs in approximately 15%.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of routine versus selective second look endoscopy in preventing peptic ulcer rebleeding.
Main Methods:
- Meta-analyses of studies comparing routine second look endoscopy with other strategies.
- Cost-effectiveness analyses evaluating different endoscopic approaches.
Main Results:
- Routine second look endoscopy, particularly with thermal coagulation, significantly reduces ulcer rebleeding.
- However, selective second look endoscopy is identified as the most cost-effective strategy.
Conclusions:
- Current guidelines do not recommend routine second look endoscopy for preventing peptic ulcer rebleeding.
- Future research should focus on identifying high-risk patients and assessing the impact of selective second look endoscopy in this population.
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