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Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial

机译：预定二看内窥镜检查对消化性溃疡出血的影响：一种预期随机化多中心试验

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摘要

Background and Aim This study aimed to investigate the effectiveness of scheduled second-look endoscopy (EGD) with endoscopic hemostasis on peptic ulcer rebleeding and to identify the risk factors related to the need for second-look EGD. Methods We prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of active bleeding, visible vessel, or adherent clot into 2 groups between August 2010 and January 2013. Hemoclip application or thermal coagulation and/or epinephrine injection were allowed for initial endoscopic therapy. The same dosage of proton pump inhibitor was injected intravenously. The study group received scheduled second-look EGD 24 to 36 hours after the initial hemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. Those patients who developed rebleeding underwent operation or radiologic intervention despite the additional endoscopic therapy. Outcome measures included rebleeding, amount of transfusion, duration of hospitalization, and mortality. Results After initial endoscopic hemostasis, 319 eligible patients were randomized into 2 groups. Sixteen?(10.1%) and 9 (5.6%) patients developed rebleeding ( P ?= .132), respectively. There was also no difference in surgical intervention (0, 0% vs 1, .6%, P >.999) or radiologic intervention (3, 1.9% vs 2, 1.2%, P ?= .683), median duration of hospitalization (6.0 vs 5.0 days, P ?= .151), amount of transfusion (2.4?±?1.7 vs 2.2 ± 1.6 units, P ?= .276), and mortality (2, 1.3% vs 2, 1.2%, P > .999) between the 2 groups. Multivariate analysis showed that grades 3 to 4 of endoscopists’ estimation to success of initial hemostasis, history of nonsteroidal anti-inflammatory drug (NSAID) use, and larger amounts of blood transfusions (≥4?units of red blood cells) were the independent risk factors of rebleeding. Conclusions A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopy?in terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood. (Clinical trial registration number: KCT0000565; 4-2010-0348.)
机译：背景技术本研究旨在探讨预定的二看内窥镜（EGD）与内窥镜止血对消化性溃疡的止血的有效性，并识别与二看EGD的需要有关的风险因素。方法方法，我们预先随机随机化，在2010年8月至2010年1月至1月期间，预科患有活性出血，可见血管或粘附凝血凝块的患有活性出血，可见血管或粘附凝块的患者。初始内窥镜治疗均允许Hemoclip施用或热凝血和/或肾上腺素注射。静脉内注射相同的质子泵抑制剂剂量。在初始止血后，在初始止血后24至36小时接收的研究组，并且如果内窥镜Stigmata持续存在，则施加进一步的治疗。尽管存在额外的内窥镜治疗，那些开发出倒闭的术后或放射学干预的患者。结果措施包括重点，输血量，住院时间和死亡率。结果初始内窥镜止血后，319名符合条件的患者被随机分为2组。十六岁？（10.1％）和9（5.6％）分别开发了患者（P？= .132）。手术干预差异（0，0％Vs 1，.6％，P> .999）或放射学干预（3,1.9％Vs 2，1.2％，P？= .683），住院中位数（6.0 vs 5.0天，p？= .151），输血量（2.4？±1.7 vs 2.2±1.6单位，p？= .276）和死亡率（2,1.3％vs 2，1.2％，p> .999）2组之间。多变量分析表明，内窥镜师对初始止血成功的3至4级，非甾体抗炎药（NSAID）使用的历史，以及较大量的输血（≥4？红细胞单位）是独立的风险重燃的因素。结论具有内窥镜止血的单一EGD不逊于调度的二看内窥镜检查？在降低消化性溃疡出血的降低速率方面。重复内窥镜检查将有助于初始内窥镜止血，使用NSAID的患者，以及更大量的转染血液。 （临床试验登记号码：KCT0000565; 4-2010-0348。）

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  • 来源
    《Gastrointestinal Endoscopy》 |2018年第2期|共9页
  • 作者

    Soo Jung Park; Hyojin Park; Yong Chan Lee; Chang Hwan Choi; Tae Joo Jeon; Jun Chul Park; Jie-Hyun Kim; Young Hoon Youn; Yu Jin Kim; Jae Hak Kim; Kwang Jae Lee; Sun Gyo Lim; Hyungkil Kim; Byoung Wook Bang;

  • 作者单位

    Department of Internal Medicine and Institute of Gastroenterology Yonsei University College of;

    Department of Internal Medicine and Institute of Gastroenterology Yonsei University College of;

    Department of Internal Medicine and Institute of Gastroenterology Yonsei University College of;

    Division of Gastroenterology Department of Internal Medicine Chung-Ang University College of;

    Division of Gastroenterology Department of Internal Medicine Inje University College of Medicine;

    Department of Internal Medicine and Institute of Gastroenterology Yonsei University College of;

    Department of Internal Medicine and Institute of Gastroenterology Yonsei University College of;

    Department of Internal Medicine and Institute of Gastroenterology Yonsei University College of;

    Department of Gastroenterology Institute for Integrative Convergence Catholic Kwandong University;

    Division of Gastroenterology Department of Internal Medicine Dongguk University College of;

    Department of Gastroenterology Ajou University School of Medicine;

    Department of Gastroenterology Ajou University School of Medicine;

    Division of Gastroenterology Department of Internal Medicine Inha University College of Medicine;

    Division of Gastroenterology Department of Internal Medicine Inha University College of Medicine;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 消化系及腹部疾病;
  • 关键词

  • 入库时间 2022-08-20 03:04:13

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