EFFECT OF PROGRAMMED ENDOSCOPIC FOLLOW-UP EXAMINATIONS ON THE REBLEEDING RATE OF GASTRIC OR DUODENAL PEPTIC-ULCERS TREATED BY INJECTION THERAPY - A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL

Background and Study Aims: A second-look endoscopy is often performed to evaluate the efficacy of a prior injection therapy in patients with bleeding peptic gastric or duodenal ulcers, Although this strategy is widely established, it does not rely on unequivocal data from control led studies. In a prospective, randomized, controlled multicenter tria l we assessed the effect of programmed endoscopic follow-up examinatio ns with eventual retreatment on the outcome of bleeding ulcers in thes e patients. Patients and Methods: One hundred and five patients with g astric or duodenal peptic ulcers presenting with active (Forrest type I) or recent (Forrest type IIa and IIb) bleeding upon endoscopy within four hours after admission were included in the study Emergency treat ment consisted of the sequential injection of both epinephrine (1:10 0 00 v/v) and up to 2 ml of fibrin/thrombin around the ulcer base. Fifty -two patients mere randomized to receive programmed endoscopic monitor ing with eventual retreatment in cases of Forrest type I, IIa, or IIb ulcers beginning within 16-24 hours after the index bleed. Follow-up e ndoscopies were continued until the macroscopic appearance revealed a Forrest tape IIc or III ulcer: Fifty-three patients in the control gro up were closely monitored, and only received a second endoscopy when t here was clinical or biochemical evidence of recurrent bleeding. The g roups did not differ with respect to age, sex, site and severity of bl eeding. Results: The numbers of patients with recurrent bleeding were similar whether they were endoscopically monitored or not (21% versus 17%, P = 0.80 chi-squared test). In addition, there was no statistical ly significant difference between the two groups with respect to the n umber of blood units transfused, need for surgical intervention, hospi tal stay or number of deaths (Mann-Whitney U-test), Improving local ul cer stigmata was not related to a better outcome. Conclusions: Program med endoscopic follow-up examinations with eventual retreatment in pat ients locally injected for an acute or recent hemorrhage from a gastri c or duodenal ulcer did not influence their outcome when compared to p atients receiving only a second endoscopic intervention upon evidence for recurrent hemorrhage, Scheduled control endoscopies cannot be reco mmended after an initial successful endoscopic treatment of peptic ulc er bleeding when selection of the patients for second-look endoscopy i s directed by the Forrest criteria.