Endoscopic naso‐biliary and ‐pancreatic duct drainage for refractory post‐bulbar duodenal ulcer bleeding

Shoji, Ayaka; Shichijo, Satoki; Fukutake, Nobuyasu

doi:10.1111/den.13781

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…Regarding the technical aspect, the latest advanced techniques for endoscopic hemostasis are thus considered to be worth evaluating 40 . Further, a recent case report indicated that the insertion of an endoscopic naso‐biliary and naso‐pancreatic duct drainage tubes to the papilla of Vater is useful for preventing rebleeding in patients with refractory bleeding from a PBDU, as it avoids the exposure of the duodenal wound to bile and pancreatic juice and facilitates wound healing 41 . Regarding systematic care, since the higher level of serum albumin could partially attenuate the rebleeding risk in PBDUs in this study, replenishing albumin preparation after initial endoscopic hemostasis would be a reasonable treatment option for such patients, especially those with low serum albumin levels.…”

Section: Discussionmentioning

confidence: 99%

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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Background Although post‐bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). Methods Data on duodenal ulcers with evidence of endoscopically‐active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in‐hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. Results Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically‐confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in‐hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in‐hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. Conclusion This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.

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Section: Discussionmentioning

confidence: 99%

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Matsuhashi

Fukuda

Abe

et al. 2021

Digestive Endoscopy

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“…Post-bulbar ulcers are exposed to chronic stimulation by bile and pancreatic secretions that delays the healing of the ulcer resulting in rebleeding, perforation, or penetration. A hemorrhagic post-bulbar ulcer refractory to repeated endoscopic hemostasis was reported to be successfully managed using naso-biliary and -pancreatic duct drainage tube insertion that prevented exposing the duodenal ulcer to bile and pancreatic secretions [13]. Otherwise, lack of specific treatment may diminish the prognosis of patients with post-bulbar duodenal ulcer bleeding.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Patients with Post-Bulbar Ulcer Bleeding Compared to Bulbar Ulcer Bleeding in the Duodenum

et al. 2021

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Background: Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. Methods: A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. Results: All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. Conclusions: Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary.

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Endoscopic naso‐biliary and ‐pancreatic duct drainage for refractory post‐bulbar duodenal ulcer bleeding

Cited by 2 publications

References 2 publications

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Nature and treatment outcomes of bleeding post‐bulbar duodenal ulcers

Long-Term Outcomes in Patients with Post-Bulbar Ulcer Bleeding Compared to Bulbar Ulcer Bleeding in the Duodenum

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