Efficacy of routine second-look endoscopy after endoscopic hemostasis in patients with acute peptic ulcer bleeding: systematic review and meta-analysis.

Q4 Medicine Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru Pub Date : 2024-04-01

Harold Benites-Goñi, Jessica Alférez-Andía, Alejandro Piscoya, Carlos Diaz-Arocutipa, Adrian V Hernandez

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Abstract

Objective: To evaluate the efficacy of scheduled second-look endoscopy in patients with acute peptic ulcer bleeding (PUB).

Materials and methods: We systematically search in four databases for randomized controlled trials (RCTs) that evaluated the usefulness of scheduled second-look endoscopy vs. single endoscopy in patients with PUB. Our primary outcome was rebleeding. Secondary outcomes were surgery, mortality, and the number of units of blood transfused (NUBT). All meta-analyses were performed using a random-effects model. Pooled risk ratio (RR) and mean difference (MD), with their 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively. The risk of bias was assessed using the Cochrane RoB 2.0 tool, and the quality of evidence (QoE) was rated with the GRADE approach.

Results: Eight full-text RCTs and two RCT abstracts were included (n=1513). We did not find differences in rebleeding (RR, 0.78; 95% CI, 0.53-1.14, moderate QoE), surgery (RR, 0.58; 95% CI, 0.29-1.15, moderate QoE), mortality (RR, 0.89; 95% CI, 0.46-1.71, moderate QoE) or NUBT (MD, -0.01 units; 95% CI, -0.3 to 0.28, low QoE) between second-look and single endoscopy. Sensitivity analyses had similar results to the main analyses.

Conclusions: Routine second-look endoscopy was not more efficacious than single endoscopy in patients with PUB.

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急性消化性溃疡出血患者内镜止血后常规二次内镜检查的疗效：系统回顾和荟萃分析。

摘要评估对急性消化性溃疡出血（PUB）患者进行定期二次内镜检查的疗效：我们在四个数据库中系统地搜索了评估预定二次内镜检查与单次内镜检查对 PUB 患者是否有用的随机对照试验 (RCT)。我们的主要结果是再出血。次要结果是手术、死亡率和输血单位数（NUBT）。所有荟萃分析均采用随机效应模型。对分类和连续性结果分别计算了汇总风险比（RR）和平均差（MD）及其 95% 置信区间（CI）。使用 Cochrane RoB 2.0 工具对偏倚风险进行评估，并采用 GRADE 方法对证据质量（QoE）进行评分：结果：共纳入了 8 项 RCT 全文和 2 项 RCT 摘要（n=1513）。我们没有发现二次内镜检查和单次内镜检查在再出血（RR，0.78；95% CI，0.53-1.14，中等QoE）、手术（RR，0.58；95% CI，0.29-1.15，中等QoE）、死亡率（RR，0.89；95% CI，0.46-1.71，中等QoE）或NUBT（MD，-0.01单位；95% CI，-0.3-0.28，低QoE）方面存在差异。敏感性分析结果与主要分析结果相似：在PUB患者中，常规二诊内镜检查并不比单次内镜检查更有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru Medicine-Medicine (all)

CiteScore

0.40

自引率

0.00%

发文量

期刊介绍： La REVISTA DE GASTROENTEROLOGíA DEL PERÚ, es la publicación oficial de la Sociedad de Gastroenterología del Perú que publica artículos originales, artículos de revisión, reporte de casos, cartas e información general de la especialidad; dirigido a los profesionales de la salud con especial interés en la gastroenterología. La Revista de Gastroenterología del Perú es una publicación de periodicidad trimestral y tiene como objetivo la publicación de artículos científicos inéditos en el campo de la gastroenterología, proporcionando información actualizada y relevante de la especialidad y áreas afines. La Revista de Gastroenterología del Perú publica artículos en dos idiomas, español e inglés, a texto completo en la versión impresa yelectrónica. Los artículos científicos son sometidos a revisores o árbitros nacionales e internacionales, especialistas que opinan bajo la modalidad de doble ciego y de manera anónima sobre la calidad y validez de los mismos. El número de revisores depende del tipo de artículo, dos revisores como mínimo para artículos originales y uno como mínimo para otros tipos de artículos.