Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial

Aim: Recurrent bleeding after initial haemostasis is an important factor that directly relates to the outcome in the management of peptic ulcer bleeding. Conflicting reports have been published concerning the effectiveness of scheduled second therapeutic endoscopy on ulcer rebleeding. We investigate the use of scheduled second endoscopy with appropriate therapy on peptic ulcer rebleeding. Methods: From August 1999 to January 2001, we prospectively randomised patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel, or adherent clot into two groups. Endoscopic therapy was standardised to initial epinephrine injection and subsequent heater probe application. The study group (n = 100) received scheduled second endoscopy 16 - 24 hours after initial haemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. The control group ( n = 94) were observed closely. Those patients that developed rebleeding in either group underwent operation if further endoscopic therapy failed. Outcome measures included ulcer rebleeding, transfusion, duration of stay, and mortality. Results: After initial endoscopic haemostasis, 194 eligible patients were randomised into two groups. Thirteen patients in the control group developed recurrent bleeding within 30 days while five patients in the study group sustained recurrent bleeding ( p = 0.0314) ( relative risks 0.33, 95% confidence interval 0.1 - 0.96). The number of patients that required surgery for recurrent bleeding was six in the control group and one in the study group ( p = 0.05). There was no difference in duration of hospital stay, transfusion, or mortality between the two groups. Conclusions: A scheduled repeat endoscopy with appropriate therapy 16 - 24 hours after initial endoscopic haemostasis reduces the number of cases of recurrent bleeding.