What determines mortality and morbidity rates in non-variceal, non-malignant upper gastrointestinal bleeding treated with urgent surgical operation

Year 2022, Volume: 15 Issue: 1, 18 - 24, 01.09.2022

Haldun Kar , Necat Cin , Yasin Peker , Evren Durak , Halis Bağ , Cengiz Tavusbay , Fevzi Cengiz

Abstract

Background: Despite the advances in treatment modalities, upper gastrointestinal (GI) bleeding is still a significant health issue. We aimed to assess the risk factors on mortality and morbidity rates in the patients that underwent surgery due to non-variceal and non-malignant bleeding from upper gastrointestinal tract.
Methods: We retrospectively examined records of 127 cases with non-variceal, non-malignant acute upper GI bleeding in the our University Hospital, General Surgery Clinic between January 1996 and December 2014.
Results: Median age was 60 (16-88) years. The most frequent cause of upper gastrointestinal bleeding was duodenal ulcer observed in 93 (73.23%) patients. The most frequent presenting complaint was melena and hematemesis observed in 66 (52%) patients. Primary suturing, bilateral truncal vagotomy and pyloroplasty were the most frequent surgical procedure performed in 79 (62.20%) patients. There were 23 (27.71%) mortalities.
Statistically, mortality and morbidity rates were found to be significantly associated with female sex (OR 6.517, 95% CI 1.559 to 27.238, p=0.010), hematemesis at presentation (OR 10.378, 95% CI 1.889 to 57.005, p=0.007), presence of comorbidity (OR 14.131, 95% CI 2.197 to 90.904, p=0.005), and high urea levels (OR 0.937, 95% CI 0.952 to 0.994, p=0.013) prior to operation.
Conclusion:
In conclusion, although surgical treatment is the most effective method to control active bleeding from the ulcer and to prevent recurrence, it is often associated with high mortality and morbidity risk due to comorbidities; therefore it should be spared for cases for whom endoscopic and interventional radiologic treatment modalities is unsuccessful.

Keywords

Gastrointestinal, bleeding, upper, surgical treatment, urgent

Thanks

We would like to thank Selin Cin M.D for her contribution and support to this manuscript.

References

• 1. Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther 2015; 6: 172-82. doi: 10.4292/wjgpt.v6.i4.172
• 2. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ 2019; 364: l536. doi: 10.1136/bmj.l536
• 3. Telaku S, Kraja B, Qirjako G, Prifti S, Fejza H. Clinical outcomes of nonvariceal upper gastrointestinal bleeding in Kosova. Turk J Gastroenterol 2014; 25: 110-5. doi: 10.5152/tjg.2014.4351
• 4. Skok P, Sinkovic A. Upper Gastrointestinal Haemorrhage: Predictive Factors of In-hospital Mortality in Patients Treated in the Medical Intensive Care Unit. J Int Med Res 2011; 39: 1016-27. doi: 10.1177/147323001103900337
• 5. Szura M, Pasternak A. Upper gastrointestinal bleeding - state of the art. Folia Med Cracov 2014; 54: 59-78.
• 6. Botianu A, Matei D, Tantau M, Acalovschi M. Mortality and need of surgical treatment in acute upper gastrointestinal bleeding: a one year study in a tertiary center with a 24 hours/day - 7 days/week endoscopy call. Has anything changed? Chirurgia (Bucur) 2013; 108: 312-8.
• 7. Özen E, Tekin F, Oruç N, Özütemiz Ö, Aydın A, Günşar F, et al. Varis dışı üst gastrointestinal sistem kanamalı 412 olgunun irdelenmesi. Akademik Gastroenteroloji Dergisi 2007; 6: 62-7.
• 8. Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316-21. doi: 10.1136/gut.38.3.316.
• 9. Önder A, Kapan M, Taşkesen F, Aliosmanoğlu İ, Arıkanoğlu Z, Gül M. Cerrahi tedavi uygulanan varis-dışı ve malignite-dışı üst gastrointestinal sistem kanamalarında mortaliteyi etkileyen faktörler. Ulusal Cerrahi Dergisi 2011; 27: 216-21. doi: 10.5097/1300-0705.UCD.1383-11.01
• 10. Yalçın M, Kara B, Öztürk NA, Ölmez Ş, Taşdoğan BE, Taş A. Epidemiology and Endoscopic Findings of the Patients Suffering from Upper Gastrointestinal System Bleeding. Dicle Tıp Dergisi 2016; 43: 73-6. doi: 10.5798/diclemedj.0921.2016.01.0641
• 11. Higashiyama M, Suzuki H, Watanabe C, Tomita K, Komoto S, Nagao S, et al. Lethal haemorrhage from duodenal ulcer due to small pancreatic cancer. Clin J Gastroenterol 2015; 8: 236-9. doi: 10.1007/s12328-015-0586-7
• 12. Mille M, Engelhardt T, Stier A. Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers. Visc Med 2021; 37: 52-62. doi: 10.1159/000513689
• 13.Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician 2012; 85: 469-76. doi: 10.3122/jabfm.2015.01.140153.
• 14. Lu M, Sun G, Zhang XL, Zhang XM, Liu QS, Huang QY, et al. Risk factors associated with mortality and increaseddrug costs in nonvariceal upper gastrointestinal bleeding. Hepatogastroenterology 2015; 62: 907-12.
• 15. Kaplan RC, Hecbert SR, Psaty BM. Risk factors for hospitalized upper or lower gastrointestinal tract bleeding in treated hypertensives. Prev Med 2002; 34: 455-62. doi: 10.1006/pmed.2002.1008.
• 16. Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: a1. doi: 10.1055/s-0034-1393172
• 17. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Piscopo R. Outpatient management for low-risk nonvariceal upper gastrointestinal bleeding: a randomized controlled trial. Gastrointest Endosc 2002; 55: 1-5. doi: 10.1067/mge.2002.119219
• 18. Gralnek IM, Stanley AJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy 2021; 53: 300-32. doi: 10.1055/a-1369-5274
• 19. Akıncı H, Yücel T, Kuroğlu E, Özkan-Gürdal S. Varis dışı üst gastrointestinal sistem kanamalarında cerrahi ve konservatif tedavi için hasta seçiminde dikkate alınacak noktalar. Ulusal Travma ve Acil Cerrahi Dergisi 2004; 10: 226-31.
• 20. Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, et al. Patient characteristics with high or low blood urea nitrogen in upper gastrointestinal bleeding. World J Gastroenterol 2015; 21: 7500-5. doı: 10.3748/wjg.v21.i24.7500
• 21. Samuel R, Bilal M, Tayyem O, Guturu P. Evaluation and management of Non-variceal upper gastrointestinal bleeding. Dis Mon 2018; 64: 333-43. doi: 10.1016/j.disamonth.2018.02.003
• 22. Dango S, Beißbarth T, Weiss E, Seif Amir Hosseini A, Raddatz D, Ellenrieder V,et al. Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding. Langenbecks Arch Surg 2017; 402: 509-19. doi: 10.1007/s00423-017-1552-2
• 23. Lee CW, Sarosi GA. Emergency Ulcer Surgery. Surg Clin North Am 2011; 91: 1-12. doi: 10.1016/j.suc.2011.06.008