[The value of routine second-look endoscopy in the management of acute gastroduodenal ulcer bleeding].
The role of routine second-look endoscopy in the management of patients with acute peptic ulcer bleeding is controversial. A more precise identification of higher risk patient group, based on both clinical and endoscopic criteria, is needed to determine whether there are high-risk patients who may benefit from this management strategy.


OBJECTIVE
Or aim was to find out whether scheduled second-look endoscopy has any beneficial effect in the clinical outcome.


METHODS
Both endoscopic and clinical data were analyzed in 274 acute gastroduodenal ulcer bleeding patients. The need for repeated endoscopic haemostatic intervention was used as a measure to evaluate the potential beneficial effect of the second look endoscopy. Patients were categorized according to the Forrest classification detected during the emergency endoscopy.


RESULTS
In the subgroup of actively bleeding patients (Forrest Ia, Ib) a second endoscopic haemostasis was performed in 23.8% of cases. In the patient subgroup with visible vessel ulcers (Forrest IIa) and in those with adherent clot covered ulcers (Forrest IIb) the needs for a repeated haemostasis were 13.0% and 13.3% respectively. Despite the not statistically significant differences, remarkable clinical impact was noted favoring scheduled second look endoscopy in patients with initially active ulcer bleeding.


CONCLUSIONS
In the light of the retrospective study results it may be concluded that the scheduled second look endoscopy strategy offers a beneficial clinical outcome for selected patients estimated to be a very high risk of re-bleeding following the initial endoscopic therapy for active bleeding.
Szocs
Katalin
K
Marosvásárhelyi Orvosi és Gyógyszerészeti Egyetem II. Belgyógyászati Klinika Marosvásárhely.
Kárász
Tibor
T
Saleh
Hussam
H
Szabó
Andrea
A
Csöndes
Mihály
M
Dancs
Nóra
N
Jánoki
Márta
M
Horváth
Zoltán
Z
Rácz
István
I
D000208:Acute Disease; D004384:Duodenoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D005773:Gastroscopy; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome