The National ASGE Survey on Upper Gastrointestinal Bleeding

Silverstein, Fred E.; Gilbert, David A.; Tedesco, Francis J.; Buenger, Nancy K.; Persing, J. A.

doi:10.1016/s0016-5107(81)73155-9

Cited by 228 publications

(74 citation statements)

References 12 publications

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“…Despite the progress in interventional treatment, the overall mortality has not been significantly reduced in the last 20 years because patients nowadays are older and suffer more often from a relevant comorbidity [5,6,7,8]. Therefore the role of surgery has changed, but is still an important part of the therapeutic concept for treating UGIB.…”

Section: Introductionmentioning

confidence: 99%

Surgical therapy for peptic ulcer and nonvariceal bleeding

Schoenberg

2001

Langenbeck's Archives of Surgery

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Wider use of endoscopic hemostasis in upper gastrointestinal bleeding (UGIB) has reduced significantly the need for operation. Nevertheless, surgery still plays a pivotal role. Failure to control bleeding endoscopically should not delay surgery when necessary, and a close cooperation between endoscopists and surgeons is essential. Initial endoscopy stops the bleeding in approximately 94% of patients and helps to identify those patients with a high or low risk of rebleeding. High-risk patients should be examined for rebleeding by clinical and endoscopic assessment within at least the first 2-3 days. Large ulcers are the most likely to rebleed, and in elderly patients with severe comorbidity showing little or no healing tendency, they benefit from repeated fibrin glue treatment. In cases of rebleeding despite initial endoscopic hemostasis and conservative treatment, another attempt to stop the hemorrhage endoscopically is justified in most patients. A subgroup of patients who are old, suffering from hypotension due to rebleeding, with large ulcers and several other illnesses should undergo surgery immediately because endoscopic intervention often fails, and these patients deteriorate quickly. The surgical procedure should be limited to safe hemostasis.

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Section: Introductionmentioning

confidence: 99%

Surgical therapy for peptic ulcer and nonvariceal bleeding

Schoenberg

2001

Langenbeck's Archives of Surgery

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“…Patients more commonly bleed from duodenal ulcers than from gastric lesions. In most series, the difference is about twofold or even greater [7,8]. Without intervention, the risk of recurrent bleeding is 5-12% per patient-year [9, 10].…”

Section: Incidence and Pathophysiology Of Peptic Ulcer Bleeding Epidementioning

confidence: 99%

Incidence and pathophysiology of peptic ulcer bleeding

Arlt

Leyh

2001

Langenbeck's Archives of Surgery

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Peptic ulcer accounts for about 50% of all cases of upper gastrointestinal bleeding. Acute mortality may be as high as 14%. Infection with Helicobacter plyori (Hp) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the predominant risk factors. While the prevalence of Hp in ulcer bleeding is still debated, there is strong evidence that eradication of bacteria reduce the risk of re-bleeding significantly. The use of NSAIDs increases the frequency of ulcer bleeding about four- to sixfold on average. Additional factors such as advanced age, concomitant use of corticosteroids or anticoagulants, prior ulcer complications and co-morbid diseases may further increase the risk of bleeding. Whether or not Hp infection also represents an additive risk factor in NSAID-related bleeding remains to be clarified. The pathophysiologic action of both Hp and NSAIDs is quite complex. Hp promotes the aggressive factor acid and damages several mucosal defence mechanisms by liberating lipopolysaccharide, urease and vacuolating cytotoxin. In NSAID toxicity the cyclo-oxygenase enzymes (COX) have been studied intensively. With the advent of COX-2-selective NSAIDs, the clinical problem of NSAID-induced ulcer bleeding may be markedly reduced or abolished completely.

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“…All cases however are exam ined endoscopically within 12 h of admission usually on the next morning. It is important to do the endoscopic investigation in the first 12 h for optimal yield [7]. Where bleeding has been substantial, an aggressive ice saline la vage of the stomach is done just prior to endoscopy.…”

Section: Hemostatic Management Protocolmentioning

confidence: 99%

“…Clinically those that have had a severe bleed with drop in hemoglobin to less than 9 g/dl or have gone into shock have a higher chance of rebleeding. Age over 60 or concomitant illnesses are also factors that significantly increase the risk of continuous or recurrent bleeding [7,[39][40][41].…”

Section: Recognizing the Risk For Rebleedingmentioning

confidence: 99%

“…If bleeding failed to stop or was recurrent, the patient had emergency sur gery where either a vagotomy and underrun ning of the bleeding vessel was done or a gas trectomy was performed [1], Unfortunately results of pharmacological therapy in acute upper gastrointestinal bleeding has been dis appointing. Currently there is no medical therapy of proven effectiveness [2][3][4], Surgery has been the treatment of choice for severe or recurrent peptic ulcer bleeding before the introduction of endoscopic hemo stasis, but emergency surgery for these cases carries a mortality of more than 15%, reach ing 40% in the elderly and those with serious medical illnesses [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Hemostasis of Bleeding Peptic Ulcers

Tekant²

1993

Dig Dis

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Developments in therapeutic endoscopy over the last decade have made it possible to perform endoscopic hemostasis for bleeding peptic ulcers. This review traces the developments in this field in the Department of Surgery of the National University of Singapore. A recently conducted prospective randomized controlled trial using intralesional adrenaline and heater probe demonstrated that initial hemostasis could be achieved in 100% of patients with actively bleeding ulcers or stigmata of recent hemorrhage. The rebleed rate was 6.6% compared with 20.3% in a well-matched control group. The recent advent of laparoscopic vagotomy and laparoscopic Billroth II gastrectomy offers a low-morbidity surgical option to long-term medical treatment for the follow-up management of patients with bleeding ulcers.

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The National ASGE Survey on Upper Gastrointestinal Bleeding

Cited by 228 publications

References 12 publications

Surgical therapy for peptic ulcer and nonvariceal bleeding

Surgical therapy for peptic ulcer and nonvariceal bleeding

Incidence and pathophysiology of peptic ulcer bleeding

Endoscopic Hemostasis of Bleeding Peptic Ulcers

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