Effect of Second-look Endoscopy on Peptic Ulcer Rebleeding in Patients With Early Resumption of Antiplatelet Agents

• Status: Terminated
• Trial end date: 2017-09-01
• Target enrollment: 0
• Participant gender: All

Summary

OBJECTIVES: Up to 15% of patients with peptic ulcer bleeding will develop rebleeding, mainly in those with ulcers of higher-risk stigmata (i.e. Forrest class Ia to IIb). Randomized trials show that second-look endoscopy is effective in reducing rebleeding rate. However, whether to withhold aspirin or other anti-platelet agents (for the treatment of established cardiovascular or cerebrovascular diseases) remains controversial. Studies have shown that although continuation of anti-platelet agents reduces mortality rate due to reduced cardiovascular and cerebrovascular events, there is a marginal increase in rebleeding risk.

HYPOTHESIS: We hypothesize that continuation of aspirin or other anti-platelet agents coupled with second-look endoscopy could reduce the rebleeding rate without increasing the risk of thromboembolic events in high-risk patients.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: The University of Hong Kong
• Treatments: Esomeprazole; Platelet Aggregation Inhibitors

Criteria

Inclusion Criteria:

• Antiplatelet for both primary and secondary prophylaxis

• Peptic ulcers of Forrest class Ia (spurting of blood), Ib (oozing of blood), IIa (visible vessel) & IIb (adherent clot)

Exclusion Criteria:

• Peptic ulcers of class IIc (pigmented ulcer base) & III (clean ulcer base)

• Unsuccessful endoscopic hemostasis

• Ulcer perforation

• Gastric outlet obstruction precluding passage of scope to D2

• Malignant ulcers

• Proton pump inhibitor (PPI) allergy

• Concomitant anticoagulants

• Pregnancy