| Theme |
Diagnoses & Treatments for Gastrointestinal Bleeding on the Basis of JGES Guidelines |
| Title |
Surgical Role in Peptic Ulcer Bleeding |
| Author |
Nobutsugu Abe |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Hirohisa Takeuchi |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Gen Nagao |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Tadahiko Masaki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Toshiyuki Mori |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Masanori Sugiyama |
Department of Surgery, Kyorin University School of Medicine |
| [ Summary ] |
The widespread use of endoscopic treatment has significantly reduced the number of patients requiring surgery. Failure to stop the bleeding with endoscopy and/or interventional radiology (IVR) is the most important indication for emergency surgery. A second attempt at endoscopic hemostasis is often effective for most patients with evidence of rebleeding after initial endoscopic control. However, an early elective/planned surgery after the initial endoscopic control to prevent life‒threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy remains controversial. Angiographic embolization may be a less invasive alternative to surgery, and may further augment endoscopic hemostasis. Surgery should not be delayed when it is considered necessary even if the patient is in shock, because any delay may lead to a lethal outcome. Patients who developed failed endoscopic/IVR hemostasis are likely to be poor surgical candidates with multiple comorbidities ; therefore, the approach to surgery has inclined towards minimal surgery to hasten surgical hemostasis among these fragile patients. We must remember that surgery still plays an important role in treating bleeding peptic ulcers. |