Role of routine second-look endoscopy in patients with acute peptic ulcer bleeding: meta-analysis of randomized controlled trials

Abstract Background and aims Studies evaluating the role of routine second-look endoscopy in patients with acute upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) have reported conflicting results. This meta-analysis evaluates the usefulness of routine second-look endoscopy in these patients. Methods We reviewed several databases from inception to September 15, 2020 to identify randomized controlled trials (RCTs) that compared routine second-look endoscopy with no planned second-look endoscopy in patients with acute UGIB due to PUD. Our outcomes of interest were recurrent bleeding, mortality, need for surgery and mean number of units of blood transfused. For categorical variables, we calculated pooled risk ratios (RR) with 95% confidence intervals (CI); for continuous variables, we calculated standardized mean difference (SMD) with 95% CI. Data were analyzed using a random effects model. We used GRADE framework to ascertain the quality of evidence. Results We included 9 RTCs comprising 1452 patients; 726 patients underwent planned/routine second-look endoscopy and 726 did not. We found no significant difference in recurrent bleeding (RR, 0.79; 95% CI, 0.51 - 1.23), need for surgery (RR, 0.58; 95% CI, 0.29 - 1.15), mortality (RR, 0.69; 95% CI, 0.33 - 1.45) or mean number of units of blood transfused (SMD, -0.06; 95% CI, -0.19 to 0.07). Quality of evidence ranged from low to moderate based on GRADE framework. Conclusion Single endoscopy with complete endoscopic hemostasis is not inferior to routine second-look endoscopy in reducing the risk of recurrent bleeding, mortality or need for surgery in patients with acute UGIB due to PUD.