Routine second look endoscopy: Evidence from six randomized trials (Part 2)
At the second look endoscopy, potentially treatable lesions were seen in 59% of patients, a small proportion of which were actively bleeding. Of the 11 patients who had recurrent bleeding in this group, two (18%) rebled before the date of their second endoscopy and, therefore, would not have been helped by this strategy. Another five (45%) rebled despite retreatment of their lesions and four (36%) did so despite having no high risk stigmata at the second endoscopy. In fact, the rebleeding rates in patients who underwent a second course of therapy and in those who were felt to be low risk at their second endoscopy were almost the same. One should note that the Forrest classification of the appearance of bleeding peptic ulcers was neither designed nor validated for patients who had already undergone endoscopic therapy. More than 40 excess endoscopies were performed in the 52 patients randomized to the second look group, and 24 patients underwent arguably unnecessary repeat endoscopic therapy when the conservative approach appeared to be equally effective.
In a study published in abstract form in 1996, Lin et al randomly assigned 115 patients to either second look endoscopy or standard care after hemostasis was achieved with epinephrine and fibrin glue. High risk stigmata were present in 42% of the second look patients at the time of the second procedure. The rebleeding rate was lower in the group receiving the routine second look (7% versus 22%). This paper has never been published as a full manuscript after nearly a decade, which should affect how much weight its results are given.