title: Early elective surgery for bleeding ulcer in the posterior duodenal bulb. Own results and review of the literature.
abstract: OBJECTIVE
  Acute upper gastrointestinal bleeding represents the major, potentially life-threatening complication of gastroduodenal ulcer disease with an average mortality of 10%. To decrease mortality a risk-dependent combined endoscopic and operative approach for the treatment of bleeding ulcer in the posterior duodenal wall was developed.
  
  
  METHODS
  Between 1998 and 2000 in our hospital a total of 22 patients with bleeding posterior duodenal bulb ulcer were treated following a differentiated endoscopic-surgical concept. High-risk patients with high bleeding activity (n = 8) underwent early elective surgery after primary endoscopic treatment of the bleeding and stabilization of the patient in an intensive care unit. The management of patients presenting a low-risk profile (n = 14) included careful surveillance and a consecutive second endoscopy 24 hours after the initial endoscopy.
  
  
  RESULTS
  Patients that underwent surgery showed more severe secondary diseases than patients of the endoscopic group. Hemoglobin concentration in patients requiring surgery was significantly lower, they showed a higher incidence of hypovolemic shock and received more blood transfusions within the first 24 hours. Mortality was 0% in both groups, a relevant rebleeding occurred in one patient after endoscopic therapy, which was successfully treated by reendoscopy with fibrin injection.
  
  
  CONCLUSIONS
  Due to these results as well as results of other groups we recommend early elective surgery in high-risk patients with bleeding duodenal bulb ulcer after primary endoscopic treatment of the bleeding.
authors: Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50931 Cologne, Germany. MoenigSt@aol.com
authors: Stefan P
authors: SP
authors: Mönig
authors: Thomas
authors: T
authors: Lübke
authors: Stefan E
authors: SE
authors: Baldus
authors: Hartmuth
authors: H
authors: Schäfer
authors: Arnulf H
authors: AH
authors: Hölscher
mesh_terms: D000328:Adult; D000368:Aged; D004381:Duodenal Ulcer / Q000150:complications*; D017558:Elective Surgical Procedures; D016145:Endoscopy, Digestive System; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery*; D019233:Retreatment; D016896:Treatment Outcome