BACKGROUND: Despite improved surgical and endoscopic technics, acute bleeding from peptic ulcer is still a serious condition, and management remains controversial. The aim of the study was to evaluate a management policy of aggressive endoscopic and restrictive surgical treatment for acute peptic ulcer bleeding. METHODS: We retrospectively investigated the course of all 341 hospital admissions during 1986 to 1990 caused by bleeding peptic ulceration from the first bleeding episode until 30 days after discharge. RESULTS: Total mortality, in-hospital 30 days' mortality, and operative mortality were 6.3%, 4.4%, and 23.5%, respectively. Risk factors associated with mortality were age and number of concomitant diseases, malignant disease, rebleeding episodes, and surgical complications. No patients without associated illness died. In 73 cases (21%) patients were treated endoscopically one or more times, and altogether 17 patients (5%) were operated on. Rebleeding occurred in 67 cases (23%), and only 23 of these were treated endoscopically at admission. Twenty-six (51%) of the rebleeding patients were treated endoscopically and 13 rebleeding patients were operated on. Two-thirds of patients presenting with arterial bleeding were managed endoscopically. No complications occurred in endoscopically treated patients, whereas there were complications in 8 of 17 operated patients. Operated patients needed significantly more intensive care unit observation time and had longer hospital stay than patients treated endoscopically. CONCLUSIONS: Endoscopic treatment is a safe procedure with a low mortality, and, if successful, the need for emergency surgery is substantially reduced. In the relatively few patients requiring surgery after unsuccessful endoscopy, the mortality remains high.
BACKGROUND: Despite improved surgical and endoscopic technics, acute bleeding from peptic ulcer is still a serious condition, and management remains controversial. The aim of the study was to evaluate a management policy of aggressive endoscopic and restrictive surgical treatment for acute peptic ulcer bleeding. METHODS: We retrospectively investigated the course of all 341 hospital admissions during 1986 to 1990 caused by bleeding peptic ulceration from the first bleeding episode until 30 days after discharge. RESULTS: Total mortality, in-hospital 30 days' mortality, and operative mortality were 6.3%, 4.4%, and 23.5%, respectively. Risk factors associated with mortality were age and number of concomitant diseases, malignant disease, rebleeding episodes, and surgical complications. No patients without associated illness died. In 73 cases (21%) patients were treated endoscopically one or more times, and altogether 17 patients (5%) were operated on. Rebleeding occurred in 67 cases (23%), and only 23 of these were treated endoscopically at admission. Twenty-six (51%) of the rebleeding patients were treated endoscopically and 13 rebleeding patients were operated on. Two-thirds of patients presenting with arterial bleeding were managed endoscopically. No complications occurred in endoscopically treated patients, whereas there were complications in 8 of 17 operated patients. Operated patients needed significantly more intensive care unit observation time and had longer hospital stay than patients treated endoscopically. CONCLUSIONS: Endoscopic treatment is a safe procedure with a low mortality, and, if successful, the need for emergency surgery is substantially reduced. In the relatively few patients requiring surgery after unsuccessful endoscopy, the mortality remains high.
Authors: Andrew J Robson; Jennifer M J Richards; Nicholas Ohly; Stephen J Nixon; Simon Paterson-Brown Journal: World J Surg Date: 2008-07 Impact factor: 3.352
Authors: Romaric Loffroy; Boris Guiu; Lise Mezzetta; Anne Minello; Christophe Michiels; Jean-Louis Jouve; Nicolas Cheynel; Patrick Rat; Jean-Pierre Cercueil; Denis Krausé Journal: Can J Gastroenterol Date: 2009-02 Impact factor: 3.522