Endoscopic Treatment and Restrictive Surgical Policy in the Management of Peptic Ulcer Bleeding: Five Years' Experience in a Central Hospital

Abstract

Qvist P, Arnesen KE, Jacobsen CD, Rosseland AR. Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding. Five years' experience in a central hospital. Scand J Gastroenterol 1994;29:569-576.

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.

Key Words:

• Endoscopic treatment
• injection therapy
• mortality
• peptic ulcer hemorrhage
• surgery