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Abstract：
BACKGROUND: Endoscopic treatment guided by Doppler endoscopic probes (DEPs) during index endoscopy may be associated with improved outcome in patients with peptic ulcer bleeding (PUB). As competencies for DEP evaluation are not always available for index endoscopy, we examined the outcome associated with DEP evaluation at second-look endoscopy.
METHODS: The study was designed as a non-blinded, parallel group, randomised controlled trial. Patients admitted with PUB from Forrest Ia-IIb ulcers, controlled by endoscopic therapy, were randomised (1:1 ratio) to second-look endoscopy <24 h with DEP evaluation of the bleeding ulcer or continued standard treatment. Patients were followed up for 30 days. The primary outcome was rebleeding. Secondary outcomes included the number of transfusions, length of hospital stay, and 30-day mortality.
RESULTS: A total of 62 patients were included. At second-look endoscopy, 91% (29/32) of patients had a positive DEP signal at the ulcer base and were treated with contact thermal therapy (n = 29), injection of diluted adrenaline (n = 23), and haemoclips (n = 7). Among the 32 patients treated with DEP evaluation, only one rebled (3%) compared to four patients (13%) in the control group (p = 0.20). There were no differences in the secondary outcomes between groups, and there were no complications related to DEP evaluation.
CONCLUSIONS: Second-look endoscopy with DEP-guided evaluation and treatment is safe and associated with a very low risk of rebleeding (3%) in patients with PUB. Second-look endoscopy with DEP evaluation may be considered in selected PUB patients at high risk of rebleeding, and may represent an alternative to the use of DEP for index endoscopy. Nevertheless, we did not find that second-look endoscopy with DEP evaluation significantly improved patient outcome compared to standard treatment.
METHODS: The study was designed as a non-blinded, parallel group, randomised controlled trial. Patients admitted with PUB from Forrest Ia-IIb ulcers, controlled by endoscopic therapy, were randomised (1:1 ratio) to second-look endoscopy <24 h with DEP evaluation of the bleeding ulcer or continued standard treatment. Patients were followed up for 30 days. The primary outcome was rebleeding. Secondary outcomes included the number of transfusions, length of hospital stay, and 30-day mortality.
RESULTS: A total of 62 patients were included. At second-look endoscopy, 91% (29/32) of patients had a positive DEP signal at the ulcer base and were treated with contact thermal therapy (n = 29), injection of diluted adrenaline (n = 23), and haemoclips (n = 7). Among the 32 patients treated with DEP evaluation, only one rebled (3%) compared to four patients (13%) in the control group (p = 0.20). There were no differences in the secondary outcomes between groups, and there were no complications related to DEP evaluation.
CONCLUSIONS: Second-look endoscopy with DEP-guided evaluation and treatment is safe and associated with a very low risk of rebleeding (3%) in patients with PUB. Second-look endoscopy with DEP evaluation may be considered in selected PUB patients at high risk of rebleeding, and may represent an alternative to the use of DEP for index endoscopy. Nevertheless, we did not find that second-look endoscopy with DEP evaluation significantly improved patient outcome compared to standard treatment.
摘要：
背景：在索引内窥镜检查期间在多普勒内窥镜探头（DEP）的引导下进行内窥镜治疗可能与改善消化性溃疡出血（PUB）患者的预后有关。由于DEP评估的能力并不总是可用于索引内窥镜检查，我们在二次内窥镜检查中检查了与DEP评估相关的结局.
方法：本研究设计为非盲法，平行组,随机对照试验。因ForrestIa-IIb溃疡而入院的PUB患者，由内窥镜治疗控制，随机(1:1比例)进行二次内镜检查<24h,DEP评估出血性溃疡或继续标准治疗。患者随访30天。主要结果是再出血。次要结果包括输血次数，住院时间,30天死亡率
结果：共纳入62例患者。在二次内窥镜检查中，91％（29/32）的患者在溃疡基底有阳性的DEP信号，并接受了接触热治疗（n=29），注射稀释的肾上腺素（n=23），和血瓣（n=7）。在接受DEP评估的32例患者中，与对照组的4例患者（13％）相比，只有1例患者（3％）（p=0.20）。两组之间的次要结局没有差异，并且没有与DEP评估相关的并发症。
结论：二次内镜检查与DEP指导的评估和治疗是安全的，并且PUB患者的再出血风险非常低（3％）。在有较高再出血风险的PUB患者中，可考虑采用DEP评估的二次内镜检查。并且可以代表使用DEP进行索引内窥镜检查的替代方案。然而，我们没有发现,与标准治疗相比,采用DEP评估的二次内镜检查可显著改善患者预后.
方法：本研究设计为非盲法，平行组,随机对照试验。因ForrestIa-IIb溃疡而入院的PUB患者，由内窥镜治疗控制，随机(1:1比例)进行二次内镜检查<24h,DEP评估出血性溃疡或继续标准治疗。患者随访30天。主要结果是再出血。次要结果包括输血次数，住院时间,30天死亡率
结果：共纳入62例患者。在二次内窥镜检查中，91％（29/32）的患者在溃疡基底有阳性的DEP信号，并接受了接触热治疗（n=29），注射稀释的肾上腺素（n=23），和血瓣（n=7）。在接受DEP评估的32例患者中，与对照组的4例患者（13％）相比，只有1例患者（3％）（p=0.20）。两组之间的次要结局没有差异，并且没有与DEP评估相关的并发症。
结论：二次内镜检查与DEP指导的评估和治疗是安全的，并且PUB患者的再出血风险非常低（3％）。在有较高再出血风险的PUB患者中，可考虑采用DEP评估的二次内镜检查。并且可以代表使用DEP进行索引内窥镜检查的替代方案。然而，我们没有发现,与标准治疗相比,采用DEP评估的二次内镜检查可显著改善患者预后.
