Endoscopic treatment and restrictive surgical policy in the management of peptic ulcer bleeding. Five years' experience in a central hospital.
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.
Qvist
P
P
Medical and Surgical Dept., Akershus Central Hospital, Nordbyhagen, Norway.
Arnesen
K E
KE
Jacobsen
C D
CD
Rosseland
A R
AR
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors