Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1984 Jan;199(1):44–50. doi: 10.1097/00000658-198401000-00008

Surgical management of bleeding chronic peptic ulcer. A 10-year prospective study.

P S Hunt
PMCID: PMC1353256  PMID: 6691730

Abstract

Analysis of experience with chronic bleeding peptic ulcer in 504 patients, admitted from 1960 to 1971, shows a hospital mortality of 12%. This retrospective review suggested that early endoscopic diagnosis, adequate resuscitation and a policy of early selective surgery was necessary if mortality was to be reduced. With this policy, there were 37 deaths in 633 patients admitted during the period of prospective study from 1972 to 1982 (5.8%). There were 25 deaths after emergency surgery in 206 patients, 56% of postoperative deaths were related to technical factors and 44% to nontechnical complications. Comparison with the retrospective study from 1961 to 1970 showed, matching in terms of incidence of shock, sex distribution and number of patients over 60 years of age. During this period, 142 emergency operations were performed, with 25 postoperative deaths, an operative mortality of 17.6%. Thirty-five deaths occurred in conservatively treated patients (9.5%) compared with 12 deaths in conservatively treated patients from 1972 to 1982 (2.6%). Within the period of prospective study, there was a significant reduction in mortality from 8%, for the first 5 years, to 3.9% for the second 5 years of study. These two periods matched except for a significant increase in the proportion of patients 60 years and over. This was mainly due to a rise in incidence of aged patients with gastric ulcer. Also noted was a decrease in mortality in patients 60 years and over which reached significance, and a significant decrease in the number of deaths in shocked patients. A significant fall in technically related postoperative complications was noted, from 44 (11 causing death) to 12 (three causing death) during the second 5 years of prospective study. There were 444 patients admitted with bleeding duodenal ulcer with 20 deaths in hospital (4.5%), and 17 deaths in 189 patients admitted with bleeding gastric ulcer, a mortality of 9%. No single factor could be isolated as the reason for the improved results. Possibly the most significant reason is the application of a defined policy in a special unit where staff became familiar with all aspects of the problem of bleeding chronic peptic ulceration.

Full text

PDF
44

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allan R., Dykes P. A study of the factors influencing mortality rates from gastrointestinal haemorrhage. Q J Med. 1976 Oct;45(180):533–550. [PubMed] [Google Scholar]
  2. Chang F. C., Drake J. E., Farha G. J. Massive upper gastrointestinal hemorrhage in the elderly. Am J Surg. 1977 Dec;134(6):721–723. doi: 10.1016/0002-9610(77)90310-5. [DOI] [PubMed] [Google Scholar]
  3. Clarke A. D., Piper D. W. Acute upper gastrointestinal haemorrhage with negative barium-meal x-ray findings: follow-up investigation. Med J Aust. 1976 Oct 23;2(17):637–638. doi: 10.5694/j.1326-5377.1976.tb98926.x. [DOI] [PubMed] [Google Scholar]
  4. Cocks J. R., Desmond A. M., Swynnerton B. F., Tanner N. C. Partial gastrectomy for haemorrhage. Gut. 1972 May;13(5):331–340. doi: 10.1136/gut.13.5.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cotton P. B., Rosenberg M. T., Waldram R. P., Axon A. T. Early endoscopy of oesophagus, stomach, and duodenal bulb in patients with haematemesis and melaena. Br Med J. 1973 Jun 2;2(5865):505–509. doi: 10.1136/bmj.2.5865.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cotton P. B., Russell R. C. Diseases of the alimentary system. Haematemesis and melaena. Br Med J. 1977 Jan 1;1(6052):37–39. doi: 10.1136/bmj.1.6052.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Devitt J. E., Brown F. N., Beattie W. G. Fatal bleeding ulcer. Ann Surg. 1966 Nov;164(5):840–844. doi: 10.1097/00000658-196611000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Eastwood G. L. Does early endoscopy benefit the patient with active upper gastrointestinal bleeding? Gastroenterology. 1977 Apr;72(4 Pt 1):737–739. [PubMed] [Google Scholar]
  9. Foster D. N., Miloszewski K. J., Losowsky M. S. Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding. Br Med J. 1978 May 6;1(6121):1173–1177. doi: 10.1136/bmj.1.6121.1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Graham D. Y. Limited value of early endoscopy in the management of acute upper gastrointestinal bleeding. Prospective controlled trial. Am J Surg. 1980 Aug;140(2):284–290. doi: 10.1016/0002-9610(80)90023-9. [DOI] [PubMed] [Google Scholar]
  11. Griffiths W. J., Neumann D. A., Welsh J. D. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med. 1979 Jun 21;300(25):1411–1413. doi: 10.1056/NEJM197906213002503. [DOI] [PubMed] [Google Scholar]
  12. HOERR S. O., DUNPHY J. E., GRAY S. J. The place of surgery in the emergency treatment of acute massive, upper gastro-intestinal hemorrhage. Surg Gynecol Obstet. 1948 Sep;87(3):338–342. [PubMed] [Google Scholar]
  13. Hellers G., Ihre T. Impact of change to early diagnosis and surgery in major upper gastrointestinal bleeding. Lancet. 1975 Dec 20;2(7947):1250–1251. doi: 10.1016/s0140-6736(75)92085-1. [DOI] [PubMed] [Google Scholar]
  14. Himal H. S., Perrault C., Mzabi R. Upper gastrointestinal hemorrhage: aggressive management decreases mortality. Surgery. 1978 Oct;84(4):448–454. [PubMed] [Google Scholar]
  15. Hunt P. S., Hansky J., Korman M. G. Mortality in patients with haematemesis and melaena: a prospective study. Br Med J. 1979 May 12;1(6173):1238–1240. doi: 10.1136/bmj.1.6173.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hunt P. S., Hansky J., Korman M. Bleeding carcinomatous ulcer of the stomach. Med J Aust. 1982 Jun 12;1(12):494–494. doi: 10.5694/j.1326-5377.1982.tb124158.x. [DOI] [PubMed] [Google Scholar]
  17. Hunt P. S., Korman M. G., Hansky J., Marshall R. D., Peck G. S., McCann W. J. Bleeding duodenal ulcer: reduction in mortality with a planned approach. Br J Surg. 1979 Sep;66(9):633–635. doi: 10.1002/bjs.1800660911. [DOI] [PubMed] [Google Scholar]
  18. JONES F. A. Haematemesis and melaena, with special reference to bleeding peptic ulcer. Br Med J. 1947 Sep 20;2(4524):441–446. doi: 10.1136/bmj.2.4524.441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Jensen H. E., Amdrup E., Christiansen P., Fenger C., Lindskov J., Nielsen J., Nielsen S. A. Bleeding gastric ulcer. Surgical and non-surgical treatment of 225 patients. Scand J Gastroenterol. 1972;7(6):535–540. doi: 10.3109/00365527209180952. [DOI] [PubMed] [Google Scholar]
  20. Johnston D. Division and repair of the sphincteric mechanism at the gastric outlet in emergency operations for bleeding peptic ulcer. A new technique for use in combination with suture ligation of the bleeding point and highly selective vagotomy. Ann Surg. 1977 Dec;186(6):723–729. doi: 10.1097/00000658-197712000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Kang J. Y., Piper D. W. Improvement in mortality rates in bleeding peptic ulcer disease: Royal North Shore Hospital of Sydney, 1947-1977. Med J Aust. 1980 Mar 8;1(5):213–215. doi: 10.5694/j.1326-5377.1980.tb134770.x. [DOI] [PubMed] [Google Scholar]
  22. Kim U., Rudick J., Aufses A. H., Jr Surgical management of acute upper gastrointestinal bleeding. Value of early diagnosis and prompt surgical intervention. Arch Surg. 1978 Dec;113(12):1444–1447. doi: 10.1001/archsurg.1978.01370240066011. [DOI] [PubMed] [Google Scholar]
  23. MacLeod I. A., Mills P. R. Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage. Br J Surg. 1982 May;69(5):256–258. doi: 10.1002/bjs.1800690509. [DOI] [PubMed] [Google Scholar]
  24. Northfield T. C. Factors predisposing to recurrent haemorrhage after acute gastrointestinal bleeding. Br Med J. 1971 Jan 2;1(5739):26–28. doi: 10.1136/bmj.1.5739.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Palmer E. D. The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. A 23-year prospective study of 1,4000 patients. JAMA. 1969 Feb 24;207(8):1477–1480. [PubMed] [Google Scholar]
  26. Read R. C., Huebl H. C., Thal A. P. Randomized study of massive bleeding from peptic ulceration. Ann Surg. 1965 Oct;162(4):561–577. doi: 10.1097/00000658-196510000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Schiller K. F., Truelove S. C., Williams D. G. Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J. 1970 Apr 4;2(5700):7–14. doi: 10.1136/bmj.2.5700.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Sereda S., Lamont I., Hunt P. The experience of a haematemesis and melaena unit: a review of the first 513 consecutive admissions. Med J Aust. 1977 Mar 12;1(11):362–366. [PubMed] [Google Scholar]
  29. TANNER N. C., DESMOND A. M. The surgical treatment of haematemesis and melaena. Postgrad Med J. 1950 May;26(295):253–266. doi: 10.1136/pgmj.26.295.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. TANNER N. C. THE DIAGNOSIS AND MANAGEMENT OF MASSIVE HAEMATEMESIS. Br J Surg. 1964 Oct;51:754–756. doi: 10.1002/bjs.1800511014. [DOI] [PubMed] [Google Scholar]
  31. THORNE F. L., NYHUS L. M. TREATMENT OF MASSIVE UPPER GASTROINTESTINAL HEMORRHAGE: A TEN-YEAR REVIEW. Am Surg. 1965 Jul;31:413–419. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES