Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2024; 16(4): 214-226
Published online Apr 16, 2024. doi: 10.4253/wjge.v16.i4.214
Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding: Meta-analysis of randomized controlled trials
Gowthami Sai Kogilathota Jagirdhar, Jose Andres Perez, Akshat Banga, Rakhtan K Qasba, Ruman K Qasba, Harsha Pattnaik, Muhammad Hussain, Yatinder Bains, Salim Surani
Gowthami Sai Kogilathota Jagirdhar, Department of Medicine, Saint Francis Health Science Center, Newark, NJ 07107, United States
Jose Andres Perez, Department of Medicine, Saint Francis Health Systems, Tulsa, OK 74133, United States
Akshat Banga, Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
Rakhtan K Qasba, Department of Medicine, Green Life Medical College and Hospital, Dhaka 1205, Bangladesh
Ruman K Qasba, Department of Medicine, Sher-i-kashmir Institute of Medical Science, Jammu, Srinagar 190011, India
Harsha Pattnaik, Department of Medicine, Lady Hardinge Medical College, New Delhi 110001, India
Muhammad Hussain, Yatinder Bains, Department of Gastroenterology, Saint Michaels Medical Center, Newark, NJ 07102, United States
Salim Surani, Department of Medicine and Pharmacology, Texas AM University, College Station, TX 77843, United States
Author contributions: Kogilathota Jagirdhar GS, Perez JA, Banga A, Qasba RK, Qasba RK, Hussain M, Bains Y, Surani S, Kogilathota Jagirdhar GS contributed to conception and design; Kogilathota Jagirdhar GS contributed to administrative support; Kogilathota Jagirdhar GS, Perez JA, Banga A, Qasba RK, Qasba RK, Hussain M contributed to provision, collection, and assembly of data; Kogilathota Jagirdhar GS, Perez JA, Banga A, Qasba RK, Qasba RK, Hussain M contributed to the review of the literature and drafting the manuscript; Kogilathota Jagirdhar GS, Bains Y, Surani S contributed to revision of key components of the manuscript and final approval of manuscript; Kogilathota Jagirdhar GS, Perez JA, Banga A, Qasba RK are accountable for all aspects of the work.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FCCP, MD, Professor, Department of Medicine and Pharmacology, Texas AM University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: December 25, 2023
Peer-review started: December 25, 2023
First decision: January 23, 2024
Revised: February 4, 2024
Accepted: April 1, 2024
Article in press: April 1, 2024
Published online: April 16, 2024
Abstract
BACKGROUND

Second-look endoscopy (SLE) to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD) is routinely being performed. Conflicting evidence exists regarding efficacy, risk, benefit, and cost-effectiveness.

AIM

To identify the role and effectiveness of SLE in ESD and PUD, associated rebleeding and PUD-related outcomes like mortality, hospital length of stay, need for endoscopic or surgical intervention and blood transfusions.

METHODS

A systematic review of literature databases PubMed, Cochrane, and Embase was conducted from inception to January 5, 2023. Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included. The study was conducted per PRISMA guidelines, and the protocol was registered in PROSPERO (ID CRD42023427555:). RevMan was used to perform meta-analysis, and Mantel-Haenszel Odds ratio (OR) were generated using random effect models.

RESULTS

A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis, of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding. In ESD, the rates of rebleeding were 7% in the SLE group compared to 4.4% in the non-SLE group with OR 1.65, 95% confidence intervals (CI) of 0.96 to 2.85; P = 0.07, whereas it was 11% in the SLE group compared to 13% in the non-SLE group with OR 0.8 95%CI: 0.50 to 1.29; P = 0.36. The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01, 95%CI: -0.22 to 0.25; P = 0.91. In SLE vs non-SLE groups with PUD, the OR for Endoscopic intervention was 0.29, 95%CI: 0.08 to 1.00; P = 0.05 while it was OR 2.03, 95%CI: 0.95 to 4.33; P = 0.07, for surgical intervention. The mean difference in the hospital length of stay was -3.57 d between the SLE and no SLE groups in PUD with 95%CI: -7.84 to 0.69; P = 0.10, denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE. For mortality between SLE and non-SLE groups in PUD, the OR was 0.88, 95%CI: 0.45 to 1.72; P = 0.70.

CONCLUSION

SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not provide any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Keywords: Endoscopy, Endoscopic submucosal dissection, Peptic ulcer, Gastrointestinal bleeding

Core Tip: Second-look endoscopy (SLE) has been a common practice to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD). Current guidelines by American college of gastroenterology and American society of gastrointestinal endoscopy do not advocate routine SLE for nonvariceal upper gastrointestinal (GI) bleeding but recommend its consideration in cases of recurrent bleeding or higher recurrence risk. Conflicting evidence exists regarding the cost-effectiveness, efficacy, and potential risks of SLE in non-variceal upper GI bleeds. Second look endoscopy does not have any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not have any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE reduced the hospital length of stay on average by 3.5 d in PUD patients.