Peptic Ulcer Disease

Answer E

Even with “ideal” endoscopic and pharmacologic therapy, the risk for rebleeding in this patient within the first 48 hours is about 5%. Endoscopy is required to both confirm the location of the re-bleeding in case therapeutic intervention fails for the second time but also to potentially control the bleeding thereby avoiding the need for surgical or angiographic intervention. Barium studies are contraindicated in this situation as they have no therapeutic potential and the barium will obscure future attempts at endoscopic intervention. While high dose continuous infusion intravenous PPI therapy is clearly indicated, in the presence of active bleeding, selective second-look endoscopy is both cost-effective and more likely to control hemorrhage. Routine second-look endoscopy is not a cost-effective strategy in patients who respond to initial dual modality (high dose PPI therapy plus dual modality endoscopic) therapy.

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