Delayed esophageal perforation after sclerotherapy

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

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.

Endoscopic injection with fibrin sealant versus epinephrine for arrest of peptic ulcer bleeding: a randomized, comparative trial

BACKGROUND

endoscopic epinephrine and fibrin injection in the treatment of bleeding peptic ulcer are reported to be safe, effective, and easy to use. However, a wide range of rebleeding rates has been reported with epinephrine injection.

GOALS

to compare the hemostatic effects of endoscopic injection with fibrin sealant versus epinephrine.

STUDY

between December 1998 and July 2000, 51 patients with active bleeding or nonbleeding visible vessels entered this trial. The clinical parameters were comparable between both groups. In the epinephrine group, we injected 5 to 10 mL of 1:10,000 epinephrine, surrounding the bleeder. In the fibrin sealant group, we injected fibrin sealant 4 mL, surrounding the bleeder.

RESULTS

initial hemostasis was obtained in all enrolled patients. Rebleeding was more in the epinephrine group than in the fibrin sealant group (4 [15%] of 26 vs. 14 [56%] of 25, = 0.003 on the intention-to-treat basis, and 4 [16.7%] of 24 vs. 14 [58.3%] of 24, = 0.003 on the per protocol basis, respectively). Volume of blood transfusion, number of surgeries, hospital stay, and number of deaths were similar between both groups.

CONCLUSION

fibrin sealant injection is more effective in preventing rebleeding than epinephrine after endoscopic therapy, but this study showed no difference in outcomes with either therapy.