Current Management of Peptic Ulcer Bleeding

Joseph Sung

Disclosures

Nat Clin Pract Gastroenterol Hepatol. 2006;3(1):24-32. 

In This Article

Second-Look Endoscopy

Despite the effectiveness of endoscopic hemostasis, rebleeding occurs in 10-25% of cases, irrespective of the method of treatment. The benefit of a routine 'second-look' endoscopy after the initial hemostasis is disputed. In a meta-analysis of four studies comparing systematic second-look endoscopy and re-treatment versus expectant treatment, Marmo et al. showed that the risk of recurrent bleeding with the former approach was reduced by 6.2%, but risk reductions for surgery and mortality were insignificant.[36] The authors concluded that appropriate selection of patients for second-look endoscopy is crucial. The selective use of second-look endoscopy and re-treatment has been supported by a single-center trial that included only Forrest I and IIa ulcers; patients were treated by a standardized endoscopic therapy in combination with intravenous omeprazole.[37] A scheduled second-look endoscopy the day after initial endoscopic hemostasis was found to prevent recurrent bleeding (relative risk 0.33, 95% CI 0.1-0.96).

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