BACKGROUND/AIMS: Acute upper gastrointestinal bleeding represents the major, potentially life-threatening complication of gastroduodenal ulcer disease with an average mortality of 10%. To decrease mortality a risk-dependent combined endoscopic and operative approach for the treatment of bleeding ulcer in the posterior duodenal wall was developed. METHODOLOGY: Between 1998 and 2000 in our hospital a total of 22 patients with bleeding posterior duodenal bulb ulcer were treated following a differentiated endoscopic-surgical concept. High-risk patients with high bleeding activity (n = 8) underwent early elective surgery after primary endoscopic treatment of the bleeding and stabilization of the patient in an intensive care unit. The management of patients presenting a low-risk profile (n = 14) included careful surveillance and a consecutive second endoscopy 24 hours after the initial endoscopy. RESULTS: Patients that underwent surgery showed more severe secondary diseases than patients of the endoscopic group. Hemoglobin concentration in patients requiring surgery was significantly lower, they showed a higher incidence of hypovolemic shock and received more blood transfusions within the first 24 hours. Mortality was 0% in both groups, a relevant rebleeding occurred in one patient after endoscopic therapy, which was successfully treated by reendoscopy with fibrin injection. CONCLUSIONS: Due to these results as well as results of other groups we recommend early elective surgery in high-risk patients with bleeding duodenal bulb ulcer after primary endoscopic treatment of the bleeding.
BACKGROUND/AIMS: Acute upper gastrointestinal bleeding represents the major, potentially life-threatening complication of gastroduodenal ulcer disease with an average mortality of 10%. To decrease mortality a risk-dependent combined endoscopic and operative approach for the treatment of bleeding ulcer in the posterior duodenal wall was developed. METHODOLOGY: Between 1998 and 2000 in our hospital a total of 22 patients with bleeding posterior duodenal bulb ulcer were treated following a differentiated endoscopic-surgical concept. High-risk patients with high bleeding activity (n = 8) underwent early elective surgery after primary endoscopic treatment of the bleeding and stabilization of the patient in an intensive care unit. The management of patients presenting a low-risk profile (n = 14) included careful surveillance and a consecutive second endoscopy 24 hours after the initial endoscopy. RESULTS:Patients that underwent surgery showed more severe secondary diseases than patients of the endoscopic group. Hemoglobin concentration in patients requiring surgery was significantly lower, they showed a higher incidence of hypovolemic shock and received more blood transfusions within the first 24 hours. Mortality was 0% in both groups, a relevant rebleeding occurred in one patient after endoscopic therapy, which was successfully treated by reendoscopy with fibrin injection. CONCLUSIONS: Due to these results as well as results of other groups we recommend early elective surgery in high-risk patients with bleeding duodenal bulb ulcer after primary endoscopic treatment of the bleeding.
Authors: David Guinier; Nicolas Destrumelle; Pierre Olivier Denue; Pierre Mathieu; Bruno Heyd; Georges Andre Mantion Journal: World J Surg Date: 2009-05 Impact factor: 3.352