EMERGENCY HEMOSTATIC SURGERY FOR HEMORRHAGIC GASTRIC ULCER
Endoscopic hemostasis is the treatment of first choice for bleeding gastric ulcer. Endoscopic submucosal or perivascular ethanol injection and microwave coagulation are widely used. These methods of endoscopic hemostasis permit control in most bleeding cases. In some cases however, endoscopic hemost...
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Published in | Kita Kantō igaku (The Kitakanto Medical Journal) Vol. 45; no. 6; pp. 551 - 555 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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The Kitakanto Medical Society
1995
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Abstract | Endoscopic hemostasis is the treatment of first choice for bleeding gastric ulcer. Endoscopic submucosal or perivascular ethanol injection and microwave coagulation are widely used. These methods of endoscopic hemostasis permit control in most bleeding cases. In some cases however, endoscopic hemostasis is impossible or re-bleeding occurs after endoscopic hemostasis. In these cases, distal gastrectomy is the most common treatment for both control of peptic ulcer and for control of bleeding. Recently, medical control of peptic ulcer has become routine and effective, so distal gastrectomy is considered to over invasive for the treatment of bleeding ulcer. In the standpoint of view, we have concluded that reliable hemostasis by direct suture is necessary to manage theses patients. For this procedure, mini-laparotomy (about 5cm length) and mini-gastrectomy is satisfactory, and it is very important for surgical invasion. Since 1994, We have encountered 12 patients in whom endoscopic hemostasis had failed and mini-laparotomic operation was performed. The average operating time was 53 minutes and average length of hospital stay was 12 days. All of the patients have been discharged and no evidence of recurrence. We therefore conclude that mini-laparotomic direct suture hemostasis is the treatment of first choice in bleeding gastric ulcer in which endoscopic management has failed. |
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AbstractList | Endoscopic hemostasis is the treatment of first choice for bleeding gastric ulcer. Endoscopic submucosal or perivascular ethanol injection and microwave coagulation are widely used. These methods of endoscopic hemostasis permit control in most bleeding cases. In some cases however, endoscopic hemostasis is impossible or re-bleeding occurs after endoscopic hemostasis. In these cases, distal gastrectomy is the most common treatment for both control of peptic ulcer and for control of bleeding. Recently, medical control of peptic ulcer has become routine and effective, so distal gastrectomy is considered to over invasive for the treatment of bleeding ulcer. In the standpoint of view, we have concluded that reliable hemostasis by direct suture is necessary to manage theses patients. For this procedure, mini-laparotomy (about 5cm length) and mini-gastrectomy is satisfactory, and it is very important for surgical invasion. Since 1994, We have encountered 12 patients in whom endoscopic hemostasis had failed and mini-laparotomic operation was performed. The average operating time was 53 minutes and average length of hospital stay was 12 days. All of the patients have been discharged and no evidence of recurrence. We therefore conclude that mini-laparotomic direct suture hemostasis is the treatment of first choice in bleeding gastric ulcer in which endoscopic management has failed. |
Author | MITUGI, SADANAO IIJIMA, KOUSAKU MIYAMOTO, YUKIO SATO, NAOHUMI OOSHIMA, KIYOHIRO TAKAI, YOSHIKI KOBAYASHI, ISAO TAKEICHI, KOREYUKI AIBA, MASAAKI HASEGAWA, SHINNJI YAMADA, ISAO |
Author_xml | – sequence: 1 fullname: SATO, NAOHUMI organization: Department of Surgery, Tomioka General Hospital – sequence: 2 fullname: TAKAI, YOSHIKI organization: Department of Surgery, Tomioka General Hospital – sequence: 3 fullname: KOBAYASHI, ISAO organization: Department of Surgery, Tomioka General Hospital – sequence: 4 fullname: YAMADA, ISAO organization: Department of Surgery, Tomioka General Hospital – sequence: 5 fullname: MITUGI, SADANAO organization: Department of Surgery, Tomioka General Hospital – sequence: 6 fullname: OOSHIMA, KIYOHIRO organization: Department of Surgery, Tomioka General Hospital – sequence: 7 fullname: AIBA, MASAAKI organization: Department of Surgery, Tomioka General Hospital – sequence: 8 fullname: TAKEICHI, KOREYUKI organization: Department of Surgery, Tomioka General Hospital – sequence: 9 fullname: HASEGAWA, SHINNJI organization: Department of Surgery, Tomioka General Hospital – sequence: 10 fullname: IIJIMA, KOUSAKU organization: Department of Surgery, Tomioka General Hospital – sequence: 11 fullname: MIYAMOTO, YUKIO organization: Gunma Prefectural College of Health Sciences |
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References | 4) 長町幸雄 : 消化性潰瘍治療の変遷.消外 15 : 297-303, 1992. 1) 浅木 茂, 西村敏明, 岩井 修ほか : 消化管出血に対する組織固定法;99.5%エタノール局注止血の試み. Gastroenterol. Endosc. 23 : 792-799, 1981. 5) 長町幸雄 : 胃・十二指腸潰瘍, 外科から.臨床外科 45 : 1367-1379, 1990. 2) 佐藤尚文, 青柳秀忠, 勅使河原修ほか : Micrwave Coagulator を用いた内視鏡的外科治療.北関東医誌 41 (5) : 757-762, 1991. 3) 亀山仁一, 鈴木 晃, 三條敏邦ほか : 出血性胃・十二指腸潰瘍の病態と治療.消外 15 : 315-322, 1992. |
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SubjectTerms | Endoscopic hemostasis Hemorrhagic gastric ulcer Minilaparotomic hemostasis |
Title | EMERGENCY HEMOSTATIC SURGERY FOR HEMORRHAGIC GASTRIC ULCER |
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