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  • Review Article
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Endoscopy for upper gastrointestinal bleeding: is routine second-look necessary?

Abstract

The benefit of routine repeat endoscopy after endoscopic hemostasis in the management of peptic ulcer bleeding is controversial. The aim of this Review is to evaluate the efficacy of second-look endoscopy by examining the evidence from published, randomized, clinical trials. Outcome measurements included recurrent bleeding, surgery, mortality, blood transfusion, and length of hospital stay. Studies were categorized into those in which endoscopy was performed with endoscopic injection or thermal coagulation. On the basis of existing evidence, second-look endoscopy with heater probe reduces the risk of recurrent bleeding, but has no effect on overall mortality or the need for surgery. Therefore, routine second-look endoscopy cannot be recommended. Selected high-risk patients may benefit from second-look endoscopy, but the use of high-dose intravenous PPIs may obviate the need for this procedure.

Key Points

  • Second-look endoscopy with repeated thermal coagulation for bleeding peptic ulcers reduces the risk of recurrent bleeding, but does not have an impact on surgical requirement or overall mortality

  • Second-look endoscopy cannot be recommended as routine practice

  • Selected groups of high-risk patients, with advanced age and/or presence of a concurrent acute life-threatening illness, may benefit from second-look endoscopy

  • High-dose intravenous PPIs may obviate the need for second-look endoscopy

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Figure 1: Clinical algorithm for the requirement of second-look endoscopy.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Correspondence to Joseph J. Y. Sung.

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Competing interests

Joseph Sung declares that he is on the Speakers Bureau for Astra Zeneca, Nycomed, Roche, GlaxoSmithKline and Bristol-Myers Squibb. He is also a Consultant for Astra Zeneca. The other authors declare no competing interests.

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Tsoi, K., Chiu, P. & Sung, J. Endoscopy for upper gastrointestinal bleeding: is routine second-look necessary?. Nat Rev Gastroenterol Hepatol 6, 717–722 (2009). https://doi.org/10.1038/nrgastro.2009.186

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