Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers.
Bleeding
Duodenal ulcer
Embolization
Endoscopy
Surgery
Journal
Visceral medicine
ISSN: 2297-4725
Titre abrégé: Visc Med
Pays: Switzerland
ID NLM: 101681546
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
29
07
2020
accepted:
09
12
2020
entrez:
15
3
2021
pubmed:
16
3
2021
medline:
16
3
2021
Statut:
ppublish
Résumé
Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment. This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined. Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.
Sections du résumé
BACKGROUND
BACKGROUND
Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment.
SUMMARY
CONCLUSIONS
This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined.
KEY MESSAGES
CONCLUSIONS
Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.
Identifiants
pubmed: 33718484
doi: 10.1159/000513689
pii: vis-0037-0052
pmc: PMC7923890
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
52-62Informations de copyright
Copyright © 2020 by S. Karger AG, Basel.
Déclaration de conflit d'intérêts
M.M. received speaker fees from Storz, Falk, and Fresenius. T.E. has no conflict of interests to declare. A.S. received speaker fees from Falk.
Références
Gut. 1996 Mar;38(3):316-21
pubmed: 8675081
Lancet Gastroenterol Hepatol. 2017 May;2(5):354-360
pubmed: 28397699
Gut. 2018 Oct;67(10):1757-1768
pubmed: 29691276
Cardiovasc Intervent Radiol. 2013 Aug;36(4):970-7
pubmed: 23152041
Ann Intern Med. 2020 Apr 21;172(8):573
pubmed: 32311706
Clin Gastroenterol Hepatol. 2015 Jan;13(1):115-21.e2
pubmed: 25058843
Gastroenterology. 2002 Aug;123(2):407-13
pubmed: 12145792
Am J Gastroenterol. 2010 Jun;105(6):1284-91
pubmed: 20051943
Gut. 2019 May;68(5):796-803
pubmed: 29802172
N Engl J Med. 2013 Jan 3;368(1):11-21
pubmed: 23281973
Radiology. 1992 Mar;182(3):703-7
pubmed: 1535883
Gastroenterology. 2013 Jul;145(1):105-112.e15
pubmed: 23470618
Br J Surg. 2012 Dec;99(12):1672-80
pubmed: 23023268
Gastrointest Endosc. 2002 Jul;56(1):1-6
pubmed: 12085028
Gastroenterology. 2018 Sep;155(3):674-686.e6
pubmed: 29803838
BMJ. 1997 Aug 30;315(7107):510-4
pubmed: 9329304
Z Gastroenterol. 2017 Sep;55(9):883-936
pubmed: 29186643
Scand J Gastroenterol. 2010 Dec;45(12):1404-15
pubmed: 20695720
Frontline Gastroenterol. 2017 Apr;8(2):94-97
pubmed: 28839892
Br J Surg. 2014 Jan;101(1):e34-50
pubmed: 24277160
Am J Gastroenterol. 2003 Jul;98(7):1494-9
pubmed: 12873568
Ann Surg. 2019 Feb;269(2):304-309
pubmed: 29064894
Clin Gastroenterol Hepatol. 2009 Jan;7(1):33-47; quiz 1-2
pubmed: 18986845
Gastrointest Endosc. 2011 Dec;74(6):1215-24
pubmed: 21907980
Endoscopy. 2012 Nov;44(11):998-1008
pubmed: 23108771
Ann Chir. 2001 Apr;126(3):232-5
pubmed: 11340708
Am J Gastroenterol. 1997 Feb;92(2):236-43
pubmed: 9040198
Lancet. 2015 Jul 11;386(9989):137-44
pubmed: 25956718
Surg Endosc. 2018 Jan;32(1):307-314
pubmed: 28656336
JAMA Intern Med. 2014 Nov;174(11):1755-62
pubmed: 25201154
Acta Radiol. 2011 Dec 1;52(10):1076-82
pubmed: 22006986
Cochrane Database Syst Rev. 2010 Jul 07;(7):CD005415
pubmed: 20614440
Lancet. 2000 Oct 14;356(9238):1318-21
pubmed: 11073021
Ann Gastroenterol. 2016 Jul-Sep;29(3):312-7
pubmed: 27366031
Am J Gastroenterol. 2008 Jul;103(7):1639-47; quiz 1648
pubmed: 18564127
J Clin Gastroenterol. 1996 Jun;22(4):267-71
pubmed: 8771420
Eur J Gastroenterol Hepatol. 2000 Feb;12(2):175-81
pubmed: 10741931
N Engl J Med. 1999 Mar 11;340(10):751-6
pubmed: 10072409
Scand J Gastroenterol. 2008;43(2):217-22
pubmed: 18224566
N Engl J Med. 2020 Apr 2;382(14):1299-1308
pubmed: 32242355
Am J Gastroenterol. 2006 Mar;101(3):500-5
pubmed: 16542286
BMJ. 2017 Jan 4;356:i6432
pubmed: 28053181
Gastrointest Endosc. 2009 Apr;69(4):786-99
pubmed: 19152905
Endosc Int Open. 2014 Mar;2(1):E6-E14
pubmed: 26134614
Chirurg. 2010 Oct;81(10):922-9
pubmed: 20464354
BMJ. 2019 Mar 25;364:l536
pubmed: 30910853
J Vasc Interv Radiol. 2001 Feb;12(2):195-200
pubmed: 11265883
Cochrane Database Syst Rev. 2013 Jun 12;(6):CD007999
pubmed: 23760821
Best Pract Res Clin Gastroenterol. 2008;22(2):209-24
pubmed: 18346679
Am J Gastroenterol. 2007 Feb;102(2):279-89; quiz 469
pubmed: 17311650
Quant Imaging Med Surg. 2019 Feb;9(2):144-145
pubmed: 30976537
Gut. 1994 Apr;35(4):464-6
pubmed: 8174982
Lancet. 1974 Aug 17;2(7877):394-7
pubmed: 4136718
Gastrointest Endosc. 1996 Feb;43(2 Pt 1):107-10
pubmed: 8635701
Am J Gastroenterol. 2004 Jul;99(7):1238-46
pubmed: 15233660
Am J Gastroenterol. 1995 Feb;90(2):206-10
pubmed: 7847286
World J Gastroenterol. 2014 Dec 14;20(46):17568-77
pubmed: 25516672
Scand J Gastroenterol. 2014 Jan;49(1):75-83
pubmed: 24256098
J Clin Gastroenterol. 2008 Apr;42(4):361-7
pubmed: 18277904
Ann Intern Med. 2009 Apr 7;150(7):455-64
pubmed: 19221370
Eur J Trauma Emerg Surg. 2020 Oct;46(5):1025-1035
pubmed: 32246169
J Clin Gastroenterol. 2015 Oct;49(9):738-45
pubmed: 25319738
Am J Gastroenterol. 2012 Mar;107(3):345-60; quiz 361
pubmed: 22310222
Arch Surg. 2008 May;143(5):457-61
pubmed: 18490553
Dig Endosc. 2016 May;28(4):363-378
pubmed: 26900095
Am J Gastroenterol. 2008 Oct;103(10):2625-32; quiz 2633
pubmed: 18684171
J Clin Gastroenterol. 2008 Feb;42(2):128-33
pubmed: 18209579
Endoscopy. 2015 Oct;47(10):a1-46
pubmed: 26417980
Langenbecks Arch Surg. 2003 Jan;387(9-10):327-36
pubmed: 12536327
World J Gastroenterol. 2006 Dec 28;12(48):7779-85
pubmed: 17203520
Scand J Gastroenterol. 2015 Mar;50(3):264-71
pubmed: 25581622
Gastrointest Endosc. 2012 Aug;76(2):283-92
pubmed: 22695209
Gut Liver. 2018 May 15;12(3):271-277
pubmed: 29409302
Radiology. 1972 Feb;102(2):303-6
pubmed: 4536688
Minim Invasive Ther Allied Technol. 2020 Jun;29(3):121-139
pubmed: 30957599
Eur J Gastroenterol Hepatol. 2012 Aug;24(8):929-38
pubmed: 22617363
J Radiol. 2007 Feb;88(2):251-8
pubmed: 17372552
Gut. 2011 Oct;60(10):1327-35
pubmed: 21490373
J Vasc Interv Radiol. 2011 Jul;22(7):911-6
pubmed: 21571546
World J Gastroenterol. 2012 Sep 14;18(34):4765-70
pubmed: 23002347
World J Emerg Surg. 2019 Sep 10;14:45
pubmed: 31516544
Clin Gastroenterol Hepatol. 2019 Feb;17(3):440-447.e2
pubmed: 29705263