Combined Endoscopic & Radiologic Intervention For Management Of Acute Perforated Peptic Ulcer : A Randomized Controlled Trial

Abstract

Background : Peptic ulcer perforation is a common and life threatening surgical emergency. The traditional , pedical omental patch is performed for the plugging of perforated peptic ulcer was first described by Cellan-Jones in 1929. Although it is attributed to Graham , who described the use of a free graft of the omentum to repair the perforation in 1937. Many endoscopic methods have been used to treat acute perforated peptic ulcer like over the scope clips , standard endoscopic clips , endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.Methods:This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 to August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management . Surgical group (SG): included 50 patients who were subjected to surgical management.Results:Hundred patients were randomized into 2 groups: Surgery Group (SG, n=50) and Endoscopy Group (EG, n=50). Median age of patients was 36( range 27:54) and 47( range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median postoperative hospital stay was 1 (range: 1-2) days in EG , while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever , pneumonia , leak , abdominal abcess , renal failure , incisional hernia, ( 11%, 5%, 5%, 3%, 2%, 3% , respectively). While postoperative complications in EG patients were 24% in form of fever , pneumonia , leak , abdominal abcess , renal failure , incisional hernia, ( 10%, 0%, 2%, 0%, 0%, 0% , respectively). Conclusion:combined endoscopic & interventional radiology can effectively manage acute perforated peptic ulcer without need for general anesthesia , within short time , in high risk surgical patients with low incidence of morbidity & mortality.This study was retrospectively submitted in clinicaltrials.gov in September 2021 (NCT05051683).

Operative versus non-operative management for perforated peptic ulcer disease

“…A prospective randomised control trial of 100 patients by Negm et al [ 15 ] comparing endoscopic treatment with surgical treatment concluded that in high-risk surgical patients, combined endoscopic and interventional radiological drainage can effectively treat acute perforated peptic ulcer without the requirement for general anaesthesia, with minimal to no additional morbidity or mortality.…”