Role of routine second-look endoscopy in patients with acute peptic ulcer bleeding: meta-analysis of randomized controlled trials.

Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Zaid Imam, Collin Henry, Dawit Jowhar, Zubair Khan, Ellen Petryna, Umair Iqbal, Claudio Tombazzi, Mohammad K Ismail, Colin W Howden

Journal: Gastrointestinal endoscopy 2021;93(6):1228-1237.e5

PMID: 33417896

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Studies evaluating the role of routine second-look endoscopy in patients with acute upper GI bleed because of peptic ulcer disease (PUD) have reported conflicting results. This meta-analysis evaluates the usefulness of routine second-look endoscopy in these patients.

METHODS

We reviewed several databases from inception to September 15, 2020 to identify randomized controlled trials (RCTs) that compared routine second-look endoscopy with no planned second-look endoscopy in patients with acute upper GI bleed because of PUD. Our outcomes of interest were recurrent bleeding, mortality, need for surgery, and mean number of units of blood transfused. For categorical variables, we calculated pooled risk ratios (RRs) with 95% confidence intervals (CIs); for continuous variables, we calculated standardized mean difference with 95% CIs. Data were analyzed using a random effects model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to ascertain the quality of evidence.

RESULTS

We included 9 RTCs comprising 1452 patients; 726 patients underwent planned/routine second-look endoscopy and 726 did not. We found no significant difference in recurrent bleeding (RR, .79; 95% CI, .51-1.23), need for surgery (RR, .58; 95% CI, .29-1.15), mortality (RR, .69; 95% CI, .33-1.45), or mean number of units of blood transfused (standardized mean difference, -.06; 95% CI, -.19 to .07). Quality of evidence ranged from low to moderate based on the GRADE framework.

CONCLUSIONS

Single endoscopy with complete endoscopic hemostasis is not inferior to routine second-look endoscopy in reducing the risk of recurrent bleeding, mortality, or need for surgery in patients with acute upper GI bleed because of PUD.

Address: Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.; Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, USA.; Department of Medicine, University of Toledo, Toledo, Ohio, USA.; Division of Gastroenterology, William Beaumont Hospital, Royal Oak, Michigan, USA.; Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.; Division of Gastroenterology, University of Texas at Houston, Houston, Texas, USA.; Division of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania.

DOI: 10.1016/j.gie.2020.12.039

Link outs

Free resources

Medical:

https://medlineplus.gov/pepticulcer.html

Other Literature Sources:

https://scite.ai/reports/33417896

Subscription / membership required

Full Text Sources:

MeSH Terms: Endoscopy, Hemostasis, Endoscopic, Humans, Peptic Ulcer, Peptic Ulcer Hemorrhage, Randomized Controlled Trials as Topic