Optimal timing of operation for bleeding peptic ulcer: prospective randomised trial.

Abstract

From October 1980 to September 1983 all patients with upper gastrointestinal bleeding were admitted to a centralised unit and investigated by early endoscopy. A total of 142 patients with a proved duodenal or gastric ulcer were randomised after stratification for age and site of ulcer to early (aggressive) surgical management or a delayed (conservative) policy. Significantly more operations (n= 42; 60%) were performed in the early than in the delayed (n=9; 20%) groups (p <0 01). There were no deaths among the 42 patients under 60. The overall mortality in the 100 patients aged over 60 was 10% and when analysed on an "intention to treat" basis there was no difference between early and delayed surgery. When, however, an unrelated death from a bleeding colonic polyp was excluded and the data analysed on "treatment received" the mortality was only 2% in the early group compared with 13% in the delayed group (p <005). When analysis was confined to gastric ulcer the difference between early (0%) and delayed (24%) treatment was even greater.The results of this trial indicate that for patients over 60 an aggressive surgical policy is associated with a significant reduction in mortality.

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

“…When the patient is old, earlier operation is recommended [149]. Recommendation 1, 80 % agreed, evidence level B.…”

APACHE II Scoring in Surgical Upper Gastrointestinal Emergencies

“…Thus, for example, McGuire and Horsley [7], operating on bleeding duodenal ulcers, reported a mortality rate of 2 1 % for TV+A and 45% for TV+D. It is widely accepted that elderly patients, especially those with associated medical disease, represent a 'highrisk' group that tolerates poorly the com bined acute insult of bleeding and the subse quent operative procedure [3,8,9]. How ever, there is general lack of agreement about the definition of the 'high-risk' patient [1,4].…”

Üst Gastroi̇ntesti̇nal Si̇stem Kanamalarinda Prognozu Etki̇leyen Faktörler

“…Re-endoskopi ile rekürren kanama oranı %10 dan aşağıya çekilebilmektedir (11). Ayrıca terapödik endoskopi cerrahi girişimin daha emin ve elektif koşullarda yapılmasına olanak sağlar ve böylece cerrahinin başarı şansı yükseltilebilir (12)(13)(14)(15)(16).…”