Optimal Timing of Feeding After Endoscopic Hemostasis in Patients With Peptic Ulcer Bleeding: A Randomized, Noninferiority Trial (CRIS KCT0001019)

The optimal duration of fasting after endoscopic hemostasis in patients with peptic ulcer bleeding has not yet been determined. We investigated the appropriate timing of feeding after endoscopic hemostasis in patients with high-risk peptic ulcer bleeding. This study was a randomized, single center,...

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Vydáno v:The American journal of gastroenterology Ročník 115; číslo 4; s. 548 - 554
Hlavní autoři: Gong, Eun Jeong, Lee, Sang Jin, Jun, Baek Gyu, Seo, Hyun Il, Park, Jong Kyu, Han, Koon Hee, Kim, Young Don, Jeong, Woo Jin, Cheon, Gab Jin, Park, Seo Young
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Wolters Kluwer 01.04.2020
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Témata:
Adult
Aged
Aged, 80 and over
Endoscopy
Fasting
Female
Food - statistics & numerical data
Gastroenterology
Hematemesis
Hemostasis, Endoscopic - methods
Hospitals
Humans
Male
Middle Aged
Mortality
Nutrition research
Patients
Peptic Ulcer Hemorrhage - therapy
Population
Prospective Studies
Recurrence
Republic of Korea
Risk Factors
Time Factors
Ulcers
Republic of Korea
ISSN:0002-9270, 1572-0241, 1572-0241
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Shrnutí:The optimal duration of fasting after endoscopic hemostasis in patients with peptic ulcer bleeding has not yet been determined. We investigated the appropriate timing of feeding after endoscopic hemostasis in patients with high-risk peptic ulcer bleeding. This study was a randomized, single center, noninferiority trial. Between February 2014 and March 2019, consecutive patients with peptic ulcer bleeding were randomized to resume feeding either 24 or 48 hours after successful endoscopic hemostasis. A total of 209 eligible patients were included in the intention-to-treat analysis and 200 in the per-protocol (PP) analysis. The primary outcome measure was recurrent bleeding within 7 days of hemostasis. Noninferiority testing was performed in the PP population, and the noninferiority margin was set at 10%. Secondary outcomes included 30-day rebleeding and mortality, transfusion requirements, and length of hospital stay. Recurrent bleeding rates at 7 days were 7.9% in the 24-hour group and 4.0% in the 48-hour group in the PP analysis; tests for noninferiority did not reach statistical significance (difference: 3.9%, 95% confidence interval [CI]: -2.7 to 10.5, P value for noninferiority = 0.034). The recurrent bleeding rates within 30 days were 10.9% and 4.0% in the 24- and 48-hour groups (difference: 6.9%, 95% CI: -0.5 to 14.2), and the 30-day mortality rates were 5.9% and 14.1%, respectively (difference: -8.2%, 95% CI: -16.5 to 0.1) in the PP analysis. The transfusion requirement and the length of hospital stay were similar between the 2 groups. Early refeeding at 24 hours after endoscopic hemostasis is not noninferior to later refeeding at 48 hours for rebleeding in patients with high-risk peptic ulcer bleeding. Our results do not allow a recommendation of refeeding at 24 hours, rather than later refeeding in this population.
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.14309/ajg.0000000000000584