Upper GI bleed: peptic ulcer: endoscopic retreatment of rebleeds caused fewer complications than surgery

Clinical bottom line (level 1b)

  1. Patients admitted with a bleeding peptic ulcer which rebleeds following endoscopy, who had repeat endoscopy compared with surgery were less likely to have complications (NNT = 5 at days) .
  2. There was no clear difference in mortality.
Lau et al: The New England Journal of Medicine 1999; 340: 751-756
Expires December 2002

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, Hong Kong

94 patients (aged mean 65, 74.4% male) with bleeding peptic ulcer who had endoscopic haemostasis and then rebled (vomiting of fresh blood, hypotension and melena; or a requirement for 4 units of blood in the 72 hours after endoscopic treatment)

Excluded if
  • cardiac arrest
  • cancer


Control Group: (n = 44, 44 analysed): surgery
Experimental Group: (n = 48, 48 analysed): endoscopic retreatment

100% followed for ? length of hospital stay

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
underwent surgery unknown 44
(100%)		 13
(27.1%)		 73%
(57% to 83%)		 72.92%
(60.3% to 85.5%)		 1
(1 to 2)
death unknown 8
(18.2%)		 5
(10.4%)		 43%
(-62% to 80%)		 7.77%
(-6.54% to 22.1%)		 13
(NNT = 5 to infinity;
NNH = 15 to infinity)
complications unknown 16
(36.4%)		 7
(14.6%)		 60%
(12% to 82%)		 21.8%
(4.41% to 39.15%)		 5
(3 to 23)

Comments

  1. The study is too small to show any difference in mortality between the two groups.
  2. There was no clear difference in the length of hospitalisation, need for an ICU stay, or number of blood transfusions.

Citation

  1. Lau JY, Sung JJ, Lam Y-H, et al: Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. The New England Journal of Medicine 1999; 340: 751-756
Contributor: Chris Ball and Musab Hayatli, December 1999
Reviewer:

Clinical Question.
    Patient bleeding peptic ulcer, that rebleeds following endoscopic therapy
    Intervention or Exposure endoscopic haemostasis
    Comparison surgery
    Outcome death, complications, rebleeding