title: What if endoscopic hemostasis fails?: Alternative treatment strategies: surgery.
abstract: Management of bleeding peptic ulcers is increasingly challenging in an aging population. Endoscopic therapy reduces the need for emergency surgery in bleeding peptic ulcers. Initial endoscopic control offers an opportunity for selecting high-risk ulcers for potential early preemptive surgery. However, such an approach has not been supported by evidence in the literature. Endoscopic retreatment can be an option to control ulcer rebleeding and reduce complications. The success of endoscopic retreatment largely depends on the severity of rebleeding and ulcer characteristics. Large chronic ulcers with urgent bleeding are less likely to respond to endoscopic retreatment. Expeditious surgery is advised.
authors.affiliation: Department of Surgery, Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong, China. Electronic address: philipchiu@surgery.cuhk.edu.hk.
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
authors.affiliation: Department of Surgery, Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong, China.
authors.forename: James Yun Wong
authors.initials: JY
authors.lastname: Lau
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D016558:Hemostasis, Endoscopic; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery* / Q000628:therapy; D019233:Retreatment; D016879:Salvage Therapy; D017211:Treatment Failure
keywords: Bleeding peptic ulcer; Surgery; Treatment