Surgical salvage of bleeding peptic ulcers after failed therapeutic endoscopy.
BACKGROUND
The approach to salvage surgery after failed endoscopic therapy for a bleeding peptic ulcer is controversial. We aimed to compare the outcomes of salvage surgery after failed endoscopic therapy for bleeding peptic ulcers over a 10-year period.


METHODS
Patients receiving salvage surgery for bleeding peptic ulcers were divided into 2 cohorts, the 1st from 1993 to 1998 and the 2nd from 1999 to 2004. The type of salvage surgery was defined as minimal if ulcer plication or an ulcerectomy was performed, and definitive if the patient received a vagotomy or gastrectomy.


RESULTS
One hundred and twenty-three patients received salvage surgery in the 1st cohort, while 42 patients received surgical hemostasis for the bleeding peptic ulcer in the 2nd cohort. Patients in the 2nd cohort consisted of a larger proportion of in-hospital bleeders (cohort 1: 12.2%, cohort 2: 42.9%; p < 0.005) and had a significantly higher proportion of comorbidities. A larger number of patients received minimal surgery in cohort 2 (cohort 1: 42.3%, cohort 2: 73.8%; p < 0.005).


CONCLUSIONS
With advances in therapeutic endoscopy, patients who developed failed endoscopic hemostasis are likely to be poor surgical candidates with multiple comorbidities. The approach to salvage surgery has inclined towards minimal surgery to hasten surgical hemostasis among these fragile patients.
Chiu
Philip Wai Yan
PW
Department of Surgery, Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China.
Ng
Enders Kwok Wai
EK
Wong
Simon Kin Hung
SK
Teoh
Anthony Yuen Bun
AY
Cheung
Frances Ka Yin
FK
Yung
Man-yee
MY
Sung
Joseph Jao Yiu
JJ
Lau
James Yun Wong
JY
D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome