Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
Nat Rev Gastroenterol Hepatol. 2009 Dec;6(12):717-22. doi: 10.1038/nrgastro.2009.186.
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.
常规重复内镜检查在消化性溃疡出血内镜止血治疗中的作用仍存在争议。本综述旨在通过评估已发表的随机临床试验的证据，评估再次内镜检查的疗效。研究的主要转归指标包括再出血、手术、死亡率、输血和住院时间。这些研究根据内镜治疗方法（内镜注射或热凝）进行了分类。基于现有证据，热探头再次内镜检查可降低再出血风险，但对总体死亡率或手术需求无影响。因此，不能常规推荐再次内镜检查。对高危患者可选择性地进行再次内镜检查，但大剂量静脉应用质子泵抑制剂可能使该操作变得没有必要。
