caa a22 4500 475802365 CHVBK 20180406123741.0 cr unu---uuuuu 170329e20000301xx s 000 0 eng 10.1007/s002689910046 doi (NATIONALLICENCE)springer-10.1007/s002689910046 Trends in Peptic Ulcer Bleeding and Surgical Treatment [Elektronische Daten] [Christian Ohmann, Michael Imhof, Hans-Dietrich Röher] An evidence-based approach is followed, with grading of evidence by study design, to evaluate surgical treatment of a bleeding peptic ulcer. In contrast to endoscopic treatment, reports of surgical treatment are rare, with only five randomized trials having been identified. Epidemiologic studies have demonstrated that the incidence of emergency surgery has not changed despite major improvements with endoscopic treatment. There are no proven alternatives to emergency operation for massive bleeding uncontrollable by endoscopic procedures. There is some debate about surgery for rebleeding, but no randomized trial has assessed whether a second endoscopic treatment alone is preferable to surgery with or without repeated endoscopic treatment. Concerning the type of operative procedure, the existing body of evidence, including two randomized studies, indicates that patients are best served by a relatively aggressive surgical approach. Today the value of these studies is limited owing to prevention of ulcer recurrence by eradication and technical improvements of local procedures (e.g., arterial ligation). Early elective surgery was tested in two randomized studies and several uncontrolled series, which demonstrated that it may be beneficial in high risk groups and harmful in others. Indications for early elective surgery should be refined taking into account updated prognostic information and more effective endoscopic treatment. Because of a new understanding of ulcer disease the role of surgery has changed markedly within the last years, no longer aiming to cure the disease but primarily to stop the hemorrhage. Evidence, however, is not derived from properly randomized controlled trials but is based on theoretic arguments and knowledge from studies not primarily dealing with operative treatment. by the Société Internationale de Chirurgie, 2000 Ohmann Christian Coordination Centre for Clinical Trials and Theoretical Surgery Unit, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany, DE aut Imhof Michael Department of General and Trauma Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany, DE aut Röher Hans-Dietrich Department of General and Trauma Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany, DE aut World Journal of Surgery Springer-Verlag 24/3(2000-03-01), 284-293 0364-2313 24:3<284 2000 24 268 https://doi.org/10.1007/s002689910046 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910046 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ohmann Christian Coordination Centre for Clinical Trials and Theoretical Surgery Unit, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany, DE aut NATIONALLICENCE 700 1- Imhof Michael Department of General and Trauma Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany, DE aut NATIONALLICENCE 700 1- Röher Hans-Dietrich Department of General and Trauma Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany, DE aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/3(2000-03-01), 284-293 0364-2313 24:3<284 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer