Peterson W L, Barnett C C, Smith H J, Allen M H, Corbett D B
N Engl J Med. 1981 Apr 16;304(16):925-9. doi: 10.1056/NEJM198104163041601.
To determine whether routine early endoscopy is beneficial to patients with upper-gastrointestinal-tract bleeding that ceases during hospitalization, we randomly assigned 206 patients to routine endoscopy (100 patients) or no routine endoscopy (106). Patients in the latter group underwent endoscopy only if recurrent bleeding occurred during hospitalization or if x-ray films disclosed gastric ulcer or suggested neoplasia. All patients were initially treated with an empiric antacid regimen. When the two groups were compared (experimental versus control), there were no significant differences in overall hospital deaths (11 versus eight), recurrence of bleeding (33 versus 32), number of transfusions required to treat recurrent bleeding (mean +/- S.E.M., 7.4 +/- 1.2 versus 6.3 +/- 0.7 units), deaths after recurrent bleeding (eight versus five), or duration of hospital stay. During the 12 months after discharge, there were also no significant differences in frequency of readmission to the hospital, incidence of further gastrointestinal bleeding, number of hemorrhage-related deaths, or frequency of gastrointestinal surgery. We conclude that endoscopy should not be a routine procedure in patients with upper-gastrointestinal-tract bleeding that ceases during treatment.
为了确定常规早期内镜检查对住院期间上消化道出血已停止的患者是否有益，我们将206例患者随机分为常规内镜检查组（100例）和非常规内镜检查组（106例）。后一组患者仅在住院期间发生再出血或X线片显示胃溃疡或提示肿瘤时才接受内镜检查。所有患者最初均接受经验性抗酸治疗方案。比较两组（试验组与对照组）时，在总体住院死亡人数（11例对8例）、出血复发率（33例对32例）、治疗再出血所需的输血量（均值±标准误，7.4±1.2单位对6.3±0.7单位）、再出血后的死亡人数（8例对5例）或住院时间方面均无显著差异。出院后的12个月内，再次入院频率、进一步胃肠道出血发生率、出血相关死亡人数或胃肠道手术频率也无显著差异。我们得出结论，对于治疗期间上消化道出血已停止的患者，内镜检查不应作为常规程序。
