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Bleeding peptic ulcer: An evolving role for surgical intervention
Author(s) -
BRANICKI FRANK J,
TING ALBERT CW,
GERTSCH PHILIP,
TUEN HENRY H,
CHU KENTMAN,
CHOW LOUIS WC,
WONG JOHN
Publication year - 1998
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1998.tb01882.x
Subject(s) - medicine , endoscopy , helicobacter pylori , peptic , surgery , peptic ulcer , intervention (counseling) , elective surgery , emergency surgery , therapeutic endoscopy , surgical emergency , general surgery , intensive care medicine , psychiatry
Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life‐threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two‐thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid‐reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.