Second-look endoscopy recommended for patients with recurrent GI bleeding
Single endoscopy was not inferior to second-look endoscopy in decreasing risk for recurrent bleeding in patients with acute upper gastrointestinal bleeding due to peptic ulcer disease, according to study results.
“Our findings lend further support to current guidelines from ACG, [European Society of Gastrointestinal Endoscopy] and an international consensus group, and would support a change in [National Institute for Clinical Excellence] guidelines,” Faisal Kamal, MD, division of gastroenterology, University of Tennessee Health Science Center, and colleagues wrote. “Based on our analysis, we recommend reserving second-look endoscopy for patients with evidence of recurrent bleeding or those in whom there was concern about the adequacy of hemostasis at the initial endoscopy.”
Kamal and colleagues reviewed databases from the inception of the databases up to Sept. 15, 2020 and identified randomized controlled trials that included 1,452 patients with acute upper gastrointestinal bleeding due to peptic ulcer disease. In these studies, 726 patients underwent planned/routine second-look endoscopy and 726 did not. Recurrent bleeding, mortality, need for surgery and mean number of units of blood transfusion served as the outcomes of interest.
Kamal and colleagues used a random effects model to analyze the data collected. They used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to determine the quality of evidence.
According to researchers, no significant difference was seen between groups regarding recurrent bleeding (RR = 0.79; 95% CI, 0.51-1.23), need for surgery (RR = 0.58; 95% CI, 0.29-1.15), mortality (RR = 0.69; 95% CI, 0.33-1.45) or mean number of units of blood transfused (standard mean difference = –0.06; 95% CI, –0.19 to 0.07).
Based on the GRADE framework, the quality of evidence ranged from low to moderate.
“The authors concluded that routine second-look endoscopy was effective in the absence of high-dose [proton pump inhibitor (PPI)] and in selected patients who were at high risk such as those with active bleeding at the initial endoscopy,” the Kamal and colleagues wrote. “However, we did not find any significant difference in the rates of recurrent bleeding or surgery between groups. Additionally, our findings also challenge the results of the previous meta-analysis about the role of second-look endoscopy in the absence of high-dose PPI and in selected patients who were at high risk.”