- Robin Spiller, Editor
VALUE OF SECOND LOOK ENDOSCOPY IN PEPTIC ULCER HAEMORRHAGE
After successful endoscopic control of a bleeding peptic ulcer there is often a temptation to rest on one’s laurels. Such patients, however, still have a 5–30% chance of rebleeding with a significant risk of mortality. Whether to merely watch and hope or to actively re-examine the bleeding site is often a difficult decision in patients who often have significant comorbidity. The large, single centre, prospective, randomised study of repeat endoscopy 16–24 hours after initial homeostasis reported in this issue goes some way to address this issue. The authors showed a significant reduction in rebleeding rates and reduction in the number requiring surgery strongly supporting the adoption of this vigorous intervention policy. Interestingly, there was no increase in complication rates for the second treatment, which the authors explain is due to the clear endoscopic view obtained in a scheduled second endoscopy, which allows better targeting of treatment than when bleeding is ongoing.
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PLATELETS ARE THE SOURCE OF INCREASED CD40 LIGAND IN IBD
CD40 ligand (CD40L) is a membrane glycoprotein related to tumor necrosis factor. Expression of CD40L and its …