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Bleeding peptic ulcer: An evolving role for surgical intervention
Frank J Branicki1, Albert Cw Ting1, Philip Gertsch1
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Journal of Gastroenterology and Hepatology
|October 5, 2017
Summary
Emergency surgery for bleeding peptic ulcers is now reserved for select cases. Therapeutic endoscopy significantly reduces rebleeding, mortality, and the need for surgery, especially in elderly patients.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Historically, early surgery was recommended for bleeding peptic ulcers in patients over 60 with hemodynamic instability.
- Current guidelines emphasize reserving emergency surgery for cases where endoscopic treatment fails or bleeding recurs.
Purpose of the Study:
- To review the evolving management strategies for bleeding peptic ulcers.
- To highlight the role of therapeutic endoscopy and medical management in reducing surgical intervention.
Main Methods:
- Review of current literature and clinical practice guidelines for bleeding peptic ulcer management.
- Analysis of outcomes associated with therapeutic endoscopy versus emergency surgery.
Main Results:
- Therapeutic endoscopy has dramatically decreased rebleeding rates, need for emergency surgery, and mortality.
- Elderly patients (octogenarians) with large ulcers (>2 cm) face increased risks.
- Two-thirds of major bleeding ulcer patients are poor surgical candidates, making surgical avoidance a priority.
Conclusions:
- Management of bleeding peptic ulcers increasingly favors endoscopic and medical therapies over emergency surgery.
- Laparoscopic surgery may be considered for hemodynamically stable patients on an elective basis if indicated.
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