PMID- 18795682
OWN - NLM
STAT- MEDLINE
DCOM- 20090113
LR  - 20080917
IS  - 0172-6390 (Print)
IS  - 0172-6390 (Linking)
VI  - 55
IP  - 85
DP  - 2008 Jul-Aug
TI  - Surgical conservative treatment of recurrent bleeding duodenal ulcer.
PG  - 1327-31
AB  - BACKGROUND/AIMS: Endoscopic hemostasis and proton pump inhibitors (PPI) have 
      decreased the incidence of rebleeding and reduced the need for surgery for 
      bleeding duodenal ulcer (BDU). The gold standard surgical treatment of BDU 
      remains vagotomy-antrectomy. Currently, no recommendation is made on the best 
      procedure when emergency surgery is necessary. The aim of this study was to 
      assess the results of a systematic conservative treatment (CT): under-running 
      bleeding gastroduodenal artery (GDA) and ulcer suture through a duodenotomy with 
      (CT+L group) or without (CT group) GDA double ligation along with continuous 
      intravenous PPI. METHODOLOGY: From 1995 to 2006, 22 consecutive patients (11 per 
      group) underwent emergency surgery for BDU. Mean age was 63 +/- 18 years, ASA 
      score 2.64 +/- 0.7. Ten patients (45%) presented collapse. Mean transfusion 
      number was 11 +/- 9, number of therapeutic endoscopies 1.7 +/- 1, and Rockall 
      score 6 +/- 2. RESULTS: Overall, 2 patients (9%) had rebleeding and 5 patients 
      (22%) died. No death was reported secondary to rebleeding. In the CT+L group, 9 
      patients (82%) had intravenous PPI, no patient had rebleeding and 2 patients died 
      (22%). CONCLUSIONS: Surgical CT of BDU with continuous PPI is effective, with a 
      low rate of rebleeding. The standard use of vagotomy-antrectomy is questionable.
FAU - Brehant, O
AU  - Brehant O
AD  - Departments of Digestive Surgery, University Hospital, University of Picardie, 
      Place Victor Pauchet, 80054 Amiens 01, France.
FAU - Duval, H
AU  - Duval H
FAU - Dumont, F
AU  - Dumont F
FAU - Fuks, D
AU  - Fuks D
FAU - Deshpande, S
AU  - Deshpande S
FAU - Verhaeghe, P
AU  - Verhaeghe P
FAU - Yzet, T
AU  - Yzet T
FAU - Bartoli, E
AU  - Bartoli E
FAU - Brazier, F
AU  - Brazier F
FAU - Mauvais, F
AU  - Mauvais F
FAU - Lobjoie, E
AU  - Lobjoie E
FAU - Dupas, J L
AU  - Dupas JL
FAU - Regimbeau, J M
AU  - Regimbeau JM
LA  - eng
PT  - Journal Article
PL  - Greece
TA  - Hepatogastroenterology
JT  - Hepato-gastroenterology
JID - 8007849
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Duodenal Ulcer/*complications/surgery
MH  - Female
MH  - Hemostasis, Surgical/*methods
MH  - Humans
MH  - Ligation
MH  - Male
MH  - Middle Aged
MH  - Peptic Ulcer Hemorrhage/*drug therapy/etiology/*surgery
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Recurrence
MH  - Retreatment
MH  - *Suture Techniques
MH  - Young Adult
EDAT- 2008/09/18 09:00
MHDA- 2009/01/14 09:00
CRDT- 2008/09/18 09:00
PHST- 2008/09/18 09:00 [pubmed]
PHST- 2009/01/14 09:00 [medline]
PHST- 2008/09/18 09:00 [entrez]
PST - ppublish
SO  - Hepatogastroenterology. 2008 Jul-Aug;55(85):1327-31.