THE EFFECT OF SCHEDULED REPEAT ENDOSCOPY ON PEPTIC ULCER REBLEEDING—A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Abstract

Aim: Recurrent bleeding after initial haemostasis in peptic ulcer haemorrhage is an important factor that directly related to increased mortality. Conflicting reports have been published concerning the effectiveness of scheduled repeat endoscopy on ulcer rebleeding. We investigate the use of scheduled repeat endoscopy with subsequent further therapy in peptic ulcer bleeding.Method: From August 1999 to January 2001, we prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel or adherent clot into two groups. Endoscopic therapy was standardized to be adrenaline injection and heater probe application. One group received scheduled second endoscopy 16–24 hours after initial endoscopic haemostasis (Group A), and further therapy applied if endoscopic stigmata persist as above. The other group received close observations (Group B). Those patients in the two groups that develop rebleeding will receive operation if further endoscopic therapy failed. The outcome measures include ulcer re‐bleeding, transfusion, length of stay, and mortality.Results: After initial endoscopic haemostasis, 196 patients were randomized to two groups. 2 patients were excluded after randomization as pathology confirmed carcinoma of stomach. The results were analyzed by using either Chi square or student t tests. Conclusion:A scheduled repeat endoscopy with appropriate therapy 16 to 24 hours after initial endoscopic haemostasis reduce the amount of peptic ulcer rebleeding siginificantly.