Impact of endoscopic therapy on outcome of operation for bleeding peptic ulcers

Since elective surgery for bleeding peptic ulcer disease has declined, the surgical opinion is that patients who undergo emergency operation have more advanced disease and possibly a poorer outcome. We examined current mortality for surgical correction of upper gastrointestinal (UGI) bleeding from peptic ulcer disease. Between July 1, 1986, and December 31, 1990, 1,213 patients had esophagogastroduodenoscopy for UGI bleeding (659 with peptic ulcer disease, 219 with gastroesophageal varices, 152 with esophagitis, 83 with other causes, and 100 with no source found). Of 110 patients with peptic ulcer disease treated by endoscopic methods, bleeding was controlled in 90, and 20 required operation for failed endoscopic control. Another 22 patients had primary operation for exigent bleeding with diagnostic endoscopy only. The overall results in our series compared favorably with two pre-therapeutic endoscopy index series (Nottingham, 1982; University of Pittsburgh, 1982). Our operation rate was 6%, with a mortality rate of 7%, compared with operation rates of 15% to 27%, with mortality rates of 21% to 22% in the historical control series. In conclusion, we found that: (1) endoscopic control of UGI bleeding from peptic ulcer disease has decreased the incidence of operation compared with historical series; (2) overall operative mortality is decreasing; and (3) the major postoperative complication is rebleeding.