Scheduled endoscopic retreatment and surveillance "second-look" endoscopy are controversial approaches to bleeding peptic ulcer management. Although some studies have shown lower recurrent bleeding rates with repeated treatments, most studies have shown no benefit. The caveats of repeated endoscopy are at least twofold. Firstly, the delay of a definitive surgical intervention may be deleterious, particularly if the patient's clinical status deteriorates during that time (Olejnik et al, 2003). Secondly, endoscopic retreatment may increase the risk to the gastric or duodenal tissues, including necrosis which could lead to perforation. Most studies suggest that the number needed to treat (NNT) to prevent one episode of recurrent bleeding is too high to recommend routine second-look endoscopy. Selection of high risk patients based on clinical and endoscopic parameters may make the NNT smaller.
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