Endoscopic Retreatment Compared with Surgery in Patients with Recurrent Bleeding after Initial Endoscopic Control of Bleeding Ulcers

TLDR

Bleeding recurs in 15–20 % of patients after endoscopic control of peptic ulcers. The study compared endoscopic retreatment versus surgery for recurrent bleeding after initial endoscopic control. The authors conducted a 40‑month prospective randomized trial enrolling 100 patients with recurrent bleeding, randomly assigning 48 to endoscopic retreatment and 44 to surgery, with recurrence defined by vomiting fresh blood, hypotension and melena, or >4 units of blood within 72 h.

Abstract

After endoscopic treatment to control bleeding of peptic ulcers, bleeding recurs in 15 to 20 percent of patients. In a prospective, randomized study, we compared endoscopic retreatment with surgery after initial endoscopy. Over a 40-month period, 1169 of 3473 adults who were admitted to our hospital with bleeding peptic ulcers underwent endoscopy to reestablish hemostasis. Of 100 patients with recurrent bleeding, 7 patients with cancer and 1 patient with cardiac arrest were excluded from the study; 48 patients were randomly assigned to undergo immediate endoscopic retreatment and 44 were assigned to undergo surgery. The type of operation used was left to the surgeon. Bleeding was considered to have recurred in the event of any one of the following: vomiting of fresh blood, hypotension and melena, or a requirement for more than four units of blood in the 72-hour period after endoscopic treatment.