Outcome of nonsurgical intervention in patients with perforated peptic ulcers.
BACKGROUND
Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer.


METHODS
Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively.


RESULTS
The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (<IV) American Society of Anesthesiologists class (83.3% vs 0%, P=.015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class (P=.018).


CONCLUSIONS
A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung, Armed Forces General Hospital, Kaohsiung, Taiwan.
Ping-Lien
PL
Lay
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Hsin-Hung
HH
Huang
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Wei-Kuo
WK
Chang
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Tsai-Yuan
TY
Hsieh
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Tien-Yu
TY
Huang
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: redstone120@gmail.com.
Hsuan-Hwai
HH
Lin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072700:Conservative Treatment / Q000379:methods*; D004381:Duodenal Ulcer / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D016896:Treatment Outcome