Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial.
Clipping
Endoscopy
Peptic ulcer
Stent
Surgical emergency
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
24 05 2022
24 05 2022
Historique:
received:
27
01
2022
accepted:
12
05
2022
entrez:
24
5
2022
pubmed:
25
5
2022
medline:
27
5
2022
Statut:
epublish
Résumé
Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage. This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management. One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1-2) days in EG, while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively). Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.
Sections du résumé
BACKGROUND
Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.
METHODS
This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management.
RESULTS
One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1-2) days in EG, while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively).
CONCLUSION
Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.
Identifiants
pubmed: 35610657
doi: 10.1186/s13017-022-00429-9
pii: 10.1186/s13017-022-00429-9
pmc: PMC9131571
doi:
Banques de données
ClinicalTrials.gov
['NCT05051683']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
24Informations de copyright
© 2022. The Author(s).
Références
Surg Clin North Am. 2018 Oct;98(5):1047-1057
pubmed: 30243446
Gastrointest Endosc. 2016 Jan;83(1):129-36
pubmed: 26318834
J Gastroenterol Hepatol. 2019 Jan;34(1):22-30
pubmed: 30069935
Saudi J Gastroenterol. 2016 Jul-Aug;22(4):309-15
pubmed: 27488326
Endoscopy. 2014;46 Suppl 1 UCTN:E49-50
pubmed: 24523178
Crit Care. 2019 Mar 27;23(1):98
pubmed: 30917843
World J Gastrointest Surg. 2017 Jan 27;9(1):1-12
pubmed: 28138363
Aliment Pharmacol Ther. 2011 Jun;33(12):1292-301
pubmed: 21517921
Surg Endosc. 2016 May;30(5):2026-9
pubmed: 26201415
Lancet. 2017 Aug 5;390(10094):613-624
pubmed: 28242110
Am Surg. 2021 Dec;87(12):1879-1885
pubmed: 34749511
Eur J Trauma Emerg Surg. 2018 Apr;44(2):251-257
pubmed: 28258286