Bleeding Gastric Ulcer: A Prospective Evaluation of Rebleeding and Mortality

Branicki, Frank J.; Boey, John; Fok, P. J.; Pritchett, C. J.; Fan, Sheung Tat; Lai, Edward C. S.; Mok, F. P. T.; Wong, Wai-Man; Lam, Shiu Kum; Hui, W. M.; Ng, Matthew; Lok, Anna S.; Lam, David K.; Tang, Alan P. K.; Coleman, S. Y.; Wong, John W.

doi:10.1111/j.1445-2197.1989.tb01630.x

Cited by 12 publications

(3 citation statements)

References 30 publications

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“…In this study, the rebleeding and mortality rates for bleeding duodenal ulcer were 11.8 and 2.7% with corresponding figures of 23.8 and 6.4% for gastric ulcer. These findings are in keeping with previous observations that gastric ulceration carries a significantly greater mortality risk than duodenal ulceration 19 …”

Section: Rebleeding and Mortalitysupporting

confidence: 93%

Bleeding peptic ulcer: An evolving role for surgical intervention

Branicki

Ting

Gertsch

et al. 1998

J of Gastro and Hepatol

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Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life‐threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two‐thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid‐reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.

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Section: Rebleeding and Mortalitysupporting

confidence: 93%

Bleeding peptic ulcer: An evolving role for surgical intervention

Branicki

Ting

Gertsch

et al. 1998

J of Gastro and Hepatol

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“…Rebleeding was defined as evidence of fresh haematemesis or melaena, a fall in haemoglobin concentration of > 2 g/dL after correction of anaemia or hypotension manifest as a drop in systolic blood pressure to 6 100 mmHg or by 50 mmHg. [23][24][25][26] Risk factors are combined into logistic regression models for rebleeding and mortality in a stepwise manner. The factor that discriminates best between outcomes is included in the model first and, thereafter, factors are only included if they cause a significant improvement in discrimination over that provided by factors already in the model.…”

Section: Methodsmentioning

confidence: 99%

Hypotension and endoscopic stigmata of recent haemorrhage in bleeding peptic ulcer: Risk models for rebleeding and mortality

Branicki¹,

Coleman²,

Lam³

et al. 1992

J of Gastro and Hepatol

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Clinical and endoscopic data were collected prospectively in 1050 patients with bleeding peptic ulcer admitted between September 1985 and July 1989 to the care of one surgical team. Seventy-nine patients underwent therapeutic endoscopy soon after admission and in 129 patients either immediate or early elective surgery was performed. Eight hundred and forty-two patients, in whom therapeutic endoscopy was not performed at any stage, underwent initial conservative management and data from this latter group are now presented. Shock on admission was defined as systolic blood pressure (BP) less than or equal to 100 mmHg on presentation. There were 10 deaths of 147 shocked patients (6.8%) compared with only 25 deaths of 695 patients (3.6%) not in shock (P less than 0.08). Bleeding recurred in 30 patients (20.4%) shocked on presentation but in only 96 (13.8%) with a BP greater than 100 mmHg (P less than 0.05). Twenty-one of 358 patients (5.9%) with endoscopic stigmata of recent haemorrhage (ESRH) died, but only 14 of 484 patients (2.9%) without such stigmata (P less than 0.05) died. In shocked patients rebleeding was evident in 21 of 73 (28.8%) cases with ESRH but in only 9 of 74 (12.2%) patients in whom ESRH were absent (P less than 0.02). In the absence of fresh blood at endoscopy rebleeding occurred in 22 of 124 (17.8%) shocked patients and only 74 of 629 (11.8%) of those not shocked on presentation (P less than 0.07). When ulcer size was documented rebleeding rates for ulcers less than or equal to 1 cm, less than or equal to 2 cm and greater than 2 cm in size were 54 of 485 (11.1%), 30 of 142 (21.2%) and 12 of 44 (27.3%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…In a multivariate analysis in 78 patients with emergency surgical treatment for bleeding peptic ulcer, the type of surgical procedure (conservative, radical) did not influence postoperative mortality, whereas bleeding was more frequent in cases of conservative surgery [45]. There are many more papers discussing the choice of emergency operative procedure for bleeding peptic ulcers, but these studies are not properly controlled [47].…”

Section: Type Of Operative Proceduresmentioning

confidence: 99%

Trends in Peptic Ulcer Bleeding and Surgical Treatment

2000

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An evidence-based approach is followed, with grading of evidence by study design, to evaluate surgical treatment of a bleeding peptic ulcer. In contrast to endoscopic treatment, reports of surgical treatment are rare, with only five randomized trials having been identified. Epidemiologic studies have demonstrated that the incidence of emergency surgery has not changed despite major improvements with endoscopic treatment. There are no proven alternatives to emergency operation for massive bleeding uncontrollable by endoscopic procedures. There is some debate about surgery for rebleeding, but no randomized trial has assessed whether a second endoscopic treatment alone is preferable to surgery with or without repeated endoscopic treatment. Concerning the type of operative procedure, the existing body of evidence, including two randomized studies, indicates that patients are best served by a relatively aggressive surgical approach. Today the value of these studies is limited owing to prevention of ulcer recurrence by eradication and technical improvements of local procedures (e.g., arterial ligation). Early elective surgery was tested in two randomized studies and several uncontrolled series, which demonstrated that it may be beneficial in high risk groups and harmful in others. Indications for early elective surgery should be refined taking into account updated prognostic information and more effective endoscopic treatment. Because of a new understanding of ulcer disease the role of surgery has changed markedly within the last years, no longer aiming to cure the disease but primarily to stop the hemorrhage. Evidence, however, is not derived from properly randomized controlled trials but is based on theoretic arguments and knowledge from studies not primarily dealing with operative treatment.

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Bleeding Gastric Ulcer: A Prospective Evaluation of Rebleeding and Mortality

Cited by 12 publications

References 30 publications

Bleeding peptic ulcer: An evolving role for surgical intervention

Bleeding peptic ulcer: An evolving role for surgical intervention

Hypotension and endoscopic stigmata of recent haemorrhage in bleeding peptic ulcer: Risk models for rebleeding and mortality

Trends in Peptic Ulcer Bleeding and Surgical Treatment

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