Giant gastric ulcers. A review of 49 cases

Traditional therapy for giant gastric ulcers (greater than 3 cm) has been gastric resection because of a presumed high risk of hemorrhage and recurrence. To determine the validity of this approach and decide whether the need for resection has been altered by the introduction of H2-blockers, the records of 10,054 gastroduodenal endoscopies performed between 1971 and 1984 were reviewed. Forty-nine patients with giant gastric ulcers were identified. Five patients had malignant ulcers. Ten patients underwent gastric resection as initial therapy. Thirty-four patients were initially treated without surgery and were divided into Group I (no H2-blockers; 9 patients) and Group II (H2-blockers; 25 patients). Medical therapy was successful in three of nine patients (33%) in Group I and in 20 of 25 patients (80%) in Group II. Of 11 patients who failed medical therapy (7 intractability, 3 recurrence, and 1 fatal hemorrhage), 10 underwent subsequent gastric resection. Of the 20 patients treated surgically (10 initial and 10 medical failures), none were readmitted for recurrent ulcer disease. These data suggest that medical therapy of benign giant gastric ulcers is often effective and not associated with an excessive incidence of complications, as believed. Successful healing of these ulcers is greatly enhanced when H2-blockers are employed. Thus, the presence of an uncomplicated benign giant gastric ulcer is not an absolute indication for gastric resection.