Asymptomatic peptic disease in patients undergoing major elective operations: a prospective endoscopic study

Postoperative bleeding is usually attributed to stress ulcers; however, occult preoperative lesions could also be responsible. To determine their frequency and nature, we prospectively examined 72 patients endoscopically prior to major elective operations. Entry criteria included a planned stay in the Surgical Intensive Care Unit, greater than 2 days, and a negative history, physical examination, and stool guaiac. Gastric and duodenal mucosae were scored separately, using a 0- to 7-point scale. Scores were graded negative (0), hyperemia (1), gastroduodenitis (2-5), mucosal erosions (6), and ulcers (7). Erosions or ulcers were found in 14% of patients and gastroduodenitis is an additional 10%. We found that none of the 27 risk factors or any combination of factors tested correlated with ulcers, erosions, or gastroduodenitis. Thus, patients with asymptomatic gastroduodenal erosions or ulcerations could not be identified preoperatively, except by endoscopy. Until the significance of these lesions as cause of postoperative bleeding is determined, we recommend routine postoperative gastric pH titration with antacids for patients undergoing major elective operations.