Doppler-Guided Second-Look Endoscopy in Peptic Ulcer Bleeding: A Randomised Controlled Trial.

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Hepatology

Background:

• Doppler endoscopic probes (DEPs) may improve outcomes in peptic ulcer bleeding (PUB).
• DEP evaluation competencies may not be available during initial endoscopy.
• This study investigates DEP evaluation at second-look endoscopy for PUB.

Purpose of the Study:

• To evaluate the outcome of second-look endoscopy with DEP evaluation in patients with peptic ulcer bleeding.
• To assess the safety and efficacy of DEP-guided treatment at second-look endoscopy.
• To compare rebleeding rates between DEP-guided second-look endoscopy and standard treatment.

Main Methods:

• A randomized controlled trial comparing second-look endoscopy with DEP evaluation versus standard treatment.
• Patients with Forrest Ia-IIb peptic ulcers, initially treated endoscopically, were randomized.
• Primary outcome was rebleeding within 30 days; secondary outcomes included transfusions, hospital stay, and mortality.

Main Results:

• One rebleeding event (3%) occurred in the DEP group versus four (13%) in the control group (p=0.20).
• DEP evaluation identified positive signals in 91% of patients, leading to further endoscopic therapy.
• No significant differences were observed in secondary outcomes, and DEP evaluation was safe.

Conclusions:

• Second-look endoscopy with DEP evaluation is safe for PUB patients, demonstrating a very low rebleeding risk.
• This strategy may be considered for selected high-risk PUB patients as an alternative to initial DEP use.
• The study did not find a statistically significant improvement in overall patient outcomes compared to standard care.