Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial

Soo Jung Park, Hyojin Park, Yong Chan Lee, Chang Hwan Choi, Tae Joo Jeon, Jun Chul Park, Jie Hyun Kim, Young Hoon Youn, Yu Jin Kim, Jae Hak Kim, Kwang Jae Lee, Sun Gyo Lim, Hyungkil Kim, Byoung Wook Bang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background and Aim: This study aimed to investigate the effectiveness of scheduled second-look endoscopy (EGD) with endoscopic hemostasis on peptic ulcer rebleeding and to identify the risk factors related to the need for second-look EGD. Methods: We prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of active bleeding, visible vessel, or adherent clot into 2 groups between August 2010 and January 2013. Hemoclip application or thermal coagulation and/or epinephrine injection were allowed for initial endoscopic therapy. The same dosage of proton pump inhibitor was injected intravenously. The study group received scheduled second-look EGD 24 to 36 hours after the initial hemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. Those patients who developed rebleeding underwent operation or radiologic intervention despite the additional endoscopic therapy. Outcome measures included rebleeding, amount of transfusion, duration of hospitalization, and mortality. Results: After initial endoscopic hemostasis, 319 eligible patients were randomized into 2 groups. Sixteen (10.1%) and 9 (5.6%) patients developed rebleeding (P =.132), respectively. There was also no difference in surgical intervention (0, 0% vs 1,.6%, P >.999) or radiologic intervention (3, 1.9% vs 2, 1.2%, P =.683), median duration of hospitalization (6.0 vs 5.0 days, P =.151), amount of transfusion (2.4 ± 1.7 vs 2.2 ± 1.6 units, P =.276), and mortality (2, 1.3% vs 2, 1.2%, P >.999) between the 2 groups. Multivariate analysis showed that grades 3 to 4 of endoscopists’ estimation to success of initial hemostasis, history of nonsteroidal anti-inflammatory drug (NSAID) use, and larger amounts of blood transfusions (≥4 units of red blood cells) were the independent risk factors of rebleeding. Conclusions: A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood. (Clinical trial registration number: KCT0000565; 4-2010-0348.)

Original languageEnglish
Pages (from-to)457-465
Number of pages9
JournalGastrointestinal Endoscopy
Volume87
Issue number2
DOIs
Publication statusPublished - 2018 Feb

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Endoscopic Hemostasis
Peptic Ulcer
Endoscopy
Multicenter Studies
Hemorrhage
Christianity
Hemostasis
Hospitalization
Mortality
Proton Pump Inhibitors
Non-Steroidal Anti-Inflammatory Agents
Blood Transfusion
Epinephrine
Anti-Inflammatory Agents
Therapeutics
Multivariate Analysis
Hot Temperature
Erythrocytes
Outcome Assessment (Health Care)
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Park, Soo Jung ; Park, Hyojin ; Lee, Yong Chan ; Choi, Chang Hwan ; Jeon, Tae Joo ; Park, Jun Chul ; Kim, Jie Hyun ; Youn, Young Hoon ; Kim, Yu Jin ; Kim, Jae Hak ; Lee, Kwang Jae ; Lim, Sun Gyo ; Kim, Hyungkil ; Bang, Byoung Wook. / Effect of scheduled second-look endoscopy on peptic ulcer bleeding : a prospective randomized multicenter trial. In: Gastrointestinal Endoscopy. 2018 ; Vol. 87, No. 2. pp. 457-465.
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abstract = "Background and Aim: This study aimed to investigate the effectiveness of scheduled second-look endoscopy (EGD) with endoscopic hemostasis on peptic ulcer rebleeding and to identify the risk factors related to the need for second-look EGD. Methods: We prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of active bleeding, visible vessel, or adherent clot into 2 groups between August 2010 and January 2013. Hemoclip application or thermal coagulation and/or epinephrine injection were allowed for initial endoscopic therapy. The same dosage of proton pump inhibitor was injected intravenously. The study group received scheduled second-look EGD 24 to 36 hours after the initial hemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. Those patients who developed rebleeding underwent operation or radiologic intervention despite the additional endoscopic therapy. Outcome measures included rebleeding, amount of transfusion, duration of hospitalization, and mortality. Results: After initial endoscopic hemostasis, 319 eligible patients were randomized into 2 groups. Sixteen (10.1{\%}) and 9 (5.6{\%}) patients developed rebleeding (P =.132), respectively. There was also no difference in surgical intervention (0, 0{\%} vs 1,.6{\%}, P >.999) or radiologic intervention (3, 1.9{\%} vs 2, 1.2{\%}, P =.683), median duration of hospitalization (6.0 vs 5.0 days, P =.151), amount of transfusion (2.4 ± 1.7 vs 2.2 ± 1.6 units, P =.276), and mortality (2, 1.3{\%} vs 2, 1.2{\%}, P >.999) between the 2 groups. Multivariate analysis showed that grades 3 to 4 of endoscopists’ estimation to success of initial hemostasis, history of nonsteroidal anti-inflammatory drug (NSAID) use, and larger amounts of blood transfusions (≥4 units of red blood cells) were the independent risk factors of rebleeding. Conclusions: A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood. (Clinical trial registration number: KCT0000565; 4-2010-0348.)",
author = "Park, {Soo Jung} and Hyojin Park and Lee, {Yong Chan} and Choi, {Chang Hwan} and Jeon, {Tae Joo} and Park, {Jun Chul} and Kim, {Jie Hyun} and Youn, {Young Hoon} and Kim, {Yu Jin} and Kim, {Jae Hak} and Lee, {Kwang Jae} and Lim, {Sun Gyo} and Hyungkil Kim and Bang, {Byoung Wook}",
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Park, SJ, Park, H, Lee, YC, Choi, CH, Jeon, TJ, Park, JC, Kim, JH, Youn, YH, Kim, YJ, Kim, JH, Lee, KJ, Lim, SG, Kim, H & Bang, BW 2018, 'Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial', Gastrointestinal Endoscopy, vol. 87, no. 2, pp. 457-465. https://doi.org/10.1016/j.gie.2017.07.024

Effect of scheduled second-look endoscopy on peptic ulcer bleeding : a prospective randomized multicenter trial. / Park, Soo Jung; Park, Hyojin; Lee, Yong Chan; Choi, Chang Hwan; Jeon, Tae Joo; Park, Jun Chul; Kim, Jie Hyun; Youn, Young Hoon; Kim, Yu Jin; Kim, Jae Hak; Lee, Kwang Jae; Lim, Sun Gyo; Kim, Hyungkil; Bang, Byoung Wook.

In: Gastrointestinal Endoscopy, Vol. 87, No. 2, 02.2018, p. 457-465.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of scheduled second-look endoscopy on peptic ulcer bleeding

T2 - a prospective randomized multicenter trial

AU - Park, Soo Jung

AU - Park, Hyojin

AU - Lee, Yong Chan

AU - Choi, Chang Hwan

AU - Jeon, Tae Joo

AU - Park, Jun Chul

AU - Kim, Jie Hyun

AU - Youn, Young Hoon

AU - Kim, Yu Jin

AU - Kim, Jae Hak

AU - Lee, Kwang Jae

AU - Lim, Sun Gyo

AU - Kim, Hyungkil

AU - Bang, Byoung Wook

PY - 2018/2

Y1 - 2018/2

N2 - Background and Aim: This study aimed to investigate the effectiveness of scheduled second-look endoscopy (EGD) with endoscopic hemostasis on peptic ulcer rebleeding and to identify the risk factors related to the need for second-look EGD. Methods: We prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of active bleeding, visible vessel, or adherent clot into 2 groups between August 2010 and January 2013. Hemoclip application or thermal coagulation and/or epinephrine injection were allowed for initial endoscopic therapy. The same dosage of proton pump inhibitor was injected intravenously. The study group received scheduled second-look EGD 24 to 36 hours after the initial hemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. Those patients who developed rebleeding underwent operation or radiologic intervention despite the additional endoscopic therapy. Outcome measures included rebleeding, amount of transfusion, duration of hospitalization, and mortality. Results: After initial endoscopic hemostasis, 319 eligible patients were randomized into 2 groups. Sixteen (10.1%) and 9 (5.6%) patients developed rebleeding (P =.132), respectively. There was also no difference in surgical intervention (0, 0% vs 1,.6%, P >.999) or radiologic intervention (3, 1.9% vs 2, 1.2%, P =.683), median duration of hospitalization (6.0 vs 5.0 days, P =.151), amount of transfusion (2.4 ± 1.7 vs 2.2 ± 1.6 units, P =.276), and mortality (2, 1.3% vs 2, 1.2%, P >.999) between the 2 groups. Multivariate analysis showed that grades 3 to 4 of endoscopists’ estimation to success of initial hemostasis, history of nonsteroidal anti-inflammatory drug (NSAID) use, and larger amounts of blood transfusions (≥4 units of red blood cells) were the independent risk factors of rebleeding. Conclusions: A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood. (Clinical trial registration number: KCT0000565; 4-2010-0348.)

AB - Background and Aim: This study aimed to investigate the effectiveness of scheduled second-look endoscopy (EGD) with endoscopic hemostasis on peptic ulcer rebleeding and to identify the risk factors related to the need for second-look EGD. Methods: We prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of active bleeding, visible vessel, or adherent clot into 2 groups between August 2010 and January 2013. Hemoclip application or thermal coagulation and/or epinephrine injection were allowed for initial endoscopic therapy. The same dosage of proton pump inhibitor was injected intravenously. The study group received scheduled second-look EGD 24 to 36 hours after the initial hemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. Those patients who developed rebleeding underwent operation or radiologic intervention despite the additional endoscopic therapy. Outcome measures included rebleeding, amount of transfusion, duration of hospitalization, and mortality. Results: After initial endoscopic hemostasis, 319 eligible patients were randomized into 2 groups. Sixteen (10.1%) and 9 (5.6%) patients developed rebleeding (P =.132), respectively. There was also no difference in surgical intervention (0, 0% vs 1,.6%, P >.999) or radiologic intervention (3, 1.9% vs 2, 1.2%, P =.683), median duration of hospitalization (6.0 vs 5.0 days, P =.151), amount of transfusion (2.4 ± 1.7 vs 2.2 ± 1.6 units, P =.276), and mortality (2, 1.3% vs 2, 1.2%, P >.999) between the 2 groups. Multivariate analysis showed that grades 3 to 4 of endoscopists’ estimation to success of initial hemostasis, history of nonsteroidal anti-inflammatory drug (NSAID) use, and larger amounts of blood transfusions (≥4 units of red blood cells) were the independent risk factors of rebleeding. Conclusions: A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood. (Clinical trial registration number: KCT0000565; 4-2010-0348.)

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