***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Forty‐nine consecutive patients with bleeding from peptic ulcers that would conventionally have required surgical intervention were r and omized to receive endoscopic injection of adrenaline ( 1 : 10000 ) or laser photocoagulation .  Patients were included only if they had a visible vessel at endoscopic examination . Five patients proceeded directly to surgery and , of the remaining 44 , 21 received laser photocoagulation and 23 injection therapy .  Haemostasis was achieved initially in all patients . There was one rebleed in the group of patients who received laser treatment and four in those treated by injection . All five patients underwent further endoscopic haemostasis according to the initial r and omization . Haemostasis was again achieved in all cases , but the patient who had undergone laser treatment  suffered recurrent haemorrhage after a further 48 h and subsequently died . Overall , one of the 21 patients receiving laser treatment  died compared with none of the 23 injected with adrenaline . Injection of adrenaline achieves similar results to laser photocoagulation for bleeding peptic ulcer Objective : We report the clinical outcomes and direct medical costs of 155 patients with severe peptic ulcer hemorrhage and a nonbleeding visible vessel at emergency endoscopy treated with endoscopic hemostasis or medical-surgical therapy .  Methods : In two consecutive , prospect i ve , r and omized , controlled trials , patients were r and omly assigned to endoscopic hemostasis ( heater probe , bipolar electrocoagulation , or injection sclerosis ) or medical-surgical treatment . Study endpoints included the incidence of severe ulcer rebleeding and emergency surgery , length of hospital stay , blood transfusion requirements , mortality rate , and direct costs of utilized health care . Direct medical costs were estimated using combined fixed and variable institutional costs for consumed re sources and Medicare reimbursement rates . Results : Compared with medical-surgical treatment , endoscopically treated patients had significantly lower rates of severe ulcer rebleeding ( p= 0.004 ) , emergency surgery ( p= 0.002 and p= 0.019 , 0.024 ) , and blood transfusions ( p= 0.025 ) . Observed inter-trial differences in ulcer rebleeding rates may be partially explained in a multivariate model by covariates of comorbid disease and inpatient ulcer bleeding . In both trials , length of hospital stay , mortality rates , and treatment-related complications were similar . Estimated median direct costs per patient differed : The first trial had lower costs with endoscopic hemostasis ( $ 4254 , vs$4620 for electrocoagulation and $ 5909 for medical-surgical treatment ) , yet the second trial yielded lower costs with medical-surgical treatment ( $ 3169 , vs$3477 for injection sclerosis and $ 4098 for heater probe ) . Conclusions : Compared with medical-surgical therapy , endoscopic hemostasis for severe ulcer hemorrhage and a nonbleeding visible vessel yielded significantly better patient outcomes and was safe . This procedure may or may not yield lower direct medical costs and cost savings A prospect i ve and r and omized trial involving 104 patients was performed to assess whether second-look endoscopy could improve the efficacy of injection therapy for bleeding ulcers . The inclusion criteria were the presence of active arterial bleeding or a non-bleeding visible vessel at emergency endoscopy . All the patients received emergency injection of 1:10,000 adrenaline and were subsequently r and omized ( 52 patients in each group ) according to whether or not they would receive a second elective endoscopy within the first 24 hours with repeated injection if a visible vessel was still identified . Both groups were well matched for clinical and endoscopic data . A tendency towards better results was noted in the group that received a second-look endoscopy ; the two groups were compared in regard to further bleeding ( 21 % versus 29 % , 95 % confidence interval of the difference = -24.3 to 8.5 ) , need for emergency surgery ( 8 % versus 15 % , 95 % confidence interval of the difference = -19.9 to 4.5 ) , transfusion requirements ( 1.7 + /- 1.9 versus 2.5 + /- 2.5 units , 95 % confidence interval of the difference = -1.6 to 0.07 ) , length of hospital stay ( 9.3 + /- 8.6 versus 11.8 + /- 10.8 days , 95 % confidence interval of the difference = -6.2 to 1.4 ) , and mortality rate ( 2 % versus 4 % ) . Although these trends did not achieve statistical significance , a type II error can not be ruled out . However , according to our results , several hundred patients would be required to demonstrate statistically these relatively small differences . ( ABSTRACT TRUNCATED AT 250 WORDS A prospect i ve r and omized trial was performed to assess the efficacy of the combined therapy of endoscopic injection of adrenaline and heater probe application in the management of patients with major peptic ulcer haemorrhage . Some 153 consecutive patients were r and omized to receive either local injection of adrenaline ( 1:10000 ) followed by heater probe thermocoagulation ( 74 patients ) or no endoscopic treatment ( 79 patients ) . The two groups were well matched with regard to age , haemoglobin concentration on admission , non‐steroidal anti‐inflammatory drug usage and endoscopic findings . More patients in the treatment group were in shock on admission ( 21 versus 13 ) . Initial haemostasis was achieved in all patients r and omized to endoscopic therapy . Rebleeding occurred in fewer treated than control patients ( five versus 16 , P = 0·01 ) . The treated group also had fewer deaths ( zero versus two ) and requirement for operation ( two versus six ) . The results show that the combination of sclerotherapy with adrenaline and subsequent thermocoagulation reduces the rate of rebleeding in peptic ulcer haemorrhage BACKGROUND There are no published , detailed assessment s of the direct costs of endoscopic hemostasis for actively bleeding peptic ulcers . We compared the direct costs of care for patients with active ulcer hemorrhage treated with endoscopic or medical-surgical therapies  and correlated these costs with patient outcomes . METHODS In a prospect i ve , r and omized , controlled trial , 31 patients with active ulcer hemorrhage at emergency endoscopy were r and omly assigned to heater probe , injection , or medical-surgical treatment . For further ulcer bleeding , heater probe and injection patients were re-treated endoscopically and medical-surgical patients were referred for surgery .  Direct costs were estimated using fixed and variable costs for re sources consumed and Medicare reimbursement rates for physician fees . RESULTS Compared to medical-surgical treatment , the heater probe and injection groups had significantly higher primary hemostasis rates ( 100 % and 90 % vs 8 % ) and lower rates of emergency surgery ( 0 % and 10 % vs 75 % ) , blood transfusions , and median direct costs per patient ( $ 4153 and $ 5247 vs $ 11,149 ) . Furthermore , compared to medical-surgical treatment , the heater probe group had a significantly lower incidence of severe ulcer rebleeding ( 11 % vs 75 % ) . CONCLUSIONS Heater probe and injection sclerosis are similarly efficacious treatments for active ulcer hemorrhage , and both treatments yield significantly lower direct costs of medical care and cost savings BACKGROUND AND STUDY AIMS Rebleeding after initial endoscopic hemostasis remains an important determinant of poor prognosis in patients with ulcer hemorrhage . Prospect i ve identification of patients who are at high risk for rebleeding  , and directing further therapeutic measures in these patients , would be expected to improve the prognosis . PATIENTS AND METHODS We used our previously described scoring system ( the Baylor Bleeding Score ) to identify patients at increased risk for rebleeding after initially successful endoscopic hemostasis , and r and omized them into retreatment and no-retreatment groups . Patients in the retreatment group received additional endoscopic heat probe therapy at 24 hours , the follow-up was otherwise similar . Forty men with major ulcer hemorrhage were r and omized , 19 to the retreatment group and 21 to the no-retreatment group . Patients in the two groups had similar Baylor Bleeding Scores , blood transfusion needs ( median three vs. two units ) , ulcer sites ( duodenal 57 % vs. 43 % ) , stigmata of hemorrhage ( actively bleeding 68 % vs 67 % ) , and received similar initial endoscopic therapy ( heat probe 240 J vs. 300 J ) . Patients in the retreatment group received additional heat probe therapy ( median 165 J ) at 24 hours . RESULTS Rebleeding , requiring significantly more blood transfusion , occurred in 24 % of the no-retreatment group patients compared to none of the retreatment group patients ( p < 0.05 ) . CONCLUSIONS Endoscopic retreatment after successful initial endoscopic hemostasis prevents rebleeding in highrisk patients with ulcer bleeding One hundred and seven consecutive patients presenting with significant peptic ulcer haemorrhage were r and omised to endoscopic injection with 3 - 10 ml of 1:100,000 adrenaline ( 55 patients , group 1 ) or to a combination of adrenaline and 5 % ethanolamine ( 52 patients , group 2 ) . All had major stigmata of haemorrhage and endoscopic injection was undertaken by a single endoscopist . The groups were well matched with regard to risk factors . Rebleeding occurred in eight of the group 1 patients and seven in the group 2 patients ; surgical operation rates , median blood transfusion requirements , and hospital stay were similar in both groups . The efficacy of either form of injection was similar whether patients presented with active bleeding or a non-bleeding visible vessel . No complications occurred . In patients presenting with significant peptic ulcer bleeding , the addition of a sclerosant confers no advantage over injection with adrenaline alone In this prospect i ve , r and omized trial , bleeding gastroduodenal ulcers in the Forrest I and II stages were treated endoscopically with injection of either fibrin glue or polidocanol . After exclusion of four patients for various reasons , 38 patients were treated with fibrin glue ( mean : 5.4 ml ) and 41 patients with polidocanol ( mean : 12.1 ml ) with control endoscopies routinely performed on days 1 , 3 , and 7 after treatment . The two groups were comparable with regard to age , sex , ulcer location and Forrest classification . Recurrent bleeding was observed in five cases in the fibrin group and in ten cases in the polidocanol group ; three and two patients in the fibrin and polidocanol groups , respectively , had to undergo surgery . We conclude that fibrin glue injection is an effective method for the treatment of bleeding gastroduodenal ulcers BACKGROUND AND STUDY AIMS A second-look endoscopy is often performed to evaluate the efficacy of a prior injection therapy in patients with bleeding peptic gastric or duodenal ulcers . Although this strategy is widely established , it does not rely on unequivocal data from controlled studies . In a prospect i ve , r and omized , controlled multicenter trial we assessed the effect of programmed endoscopic follow-up examinations with eventual retreatment on the outcome of  bleeding ulcers in these patients . PATIENTS AND METHODS One hundred and five patients with gastric or duodenal peptic ulcers presenting with active ( Forrest type I ) or recent ( Forrest type IIa and IIb ) bleeding upon endoscopy within four hours after admission were included in the study . Emergency treatment consisted of the sequential injection of both epinephrine ( 1:10,000 v/v ) and up to 2 ml of fibrin/thrombin around the ulcer base . Fifty-two patients were r and omized to receive programmed endoscopic monitoring with eventual retreatment in cases of Forrest type I , IIa , or IIb ulcers beginning within 16 - 24 hours after the index bleed . Follow-up endoscopies were continued until the macroscopic appearance revealed a Forrest type IIc or III ulcer . Fifty-three patients in the control group were closely monitored , and only received a second endoscopy when there was clinical or biochemical evidence of recurrent bleeding . The groups did not differ with respect to age , sex , site and severity of bleeding . RESULTS The numbers of patients with recurrent bleeding were similar whether they were endoscopically monitored or not ( 21 % versus 17 % , P=0.80 chi-squared test ) . In addition , there was no statistically significant difference between the two groups with respect to the number of blood units transfused , need for surgical intervention , hospital stay or number of deaths ( Mann-Whitney U-test ) . Improving local ulcer stigmata was not related to a better outcome . CONCLUSIONS Programmed endoscopic follow-up examinations with eventual retreatment in patients locally injected for an acute or recent hemorrhage from a gastric or duodenal ulcer did not influence their outcome when compared to patients receiving only a second endoscopic intervention upon evidence for recurrent hemorrhage . Scheduled control endoscopies can not be recommended after an initial successful endoscopic treatment of peptic ulcer bleeding when selection of the patients for second-look endoscopy is directed by the Forrest criteria A controlled , r and omised study was performed to evaluate the efficacy of treatment with heater probe in the prevention of  rebleeding from peptic ulcer with a non-bleeding visible vessel 
    Output:
    
The i.v .
PPIs fell below 9 % and when the cost of i.v .
: Compared with the usual practice of “ watchful waiting , ” performing selective second look endoscopy in high risk patients may prevent more cases of rebleeding , surgery , or death at a lower overall cost .
However , i.v .
PPIs are likely to reduce the need for second look endoscopy and may be preferred overall if the rebleed rate and cost of i.v .
PPIs remains low