Bleeding gastroduodenal ulcer with a high risk of recurrence. Treatment tactics
V. V. Bedin,
I. Yu. Korzheva,
A. V. Vlasenko,
G. S. Mikhaylyants,
V. A. Turkan,
D. S. Bocharnikov,
K. A. Sokolov https://doi.org/10.17238/2072-3180-2025-2-200-212
Abstract
Acute bleeding ulcer is still the main cause of hospitalization. This review presents a structured approach to the modern treatment of ulcerative bleeding and highlights the strategy in situations where there is a high risk. The initial methods of treatment – pharmacotherapy and endoscopy, as well as risk stratification, surgery and X-ray endovascular embolization are considered, and their role in the treatment of ulcerative bleeding with a high risk is critically discussed. The perspective regarding preventive X-ray endovascular embolization is highlighted. In addition to the achievements of pharmacotherapy and endoscopy, the treatment of bleeding with a high risk remains a difficult task. When endoscopy is ineffective and the bleeding does not stop or recurs, surgical and radiological methods are indicated for its relief. Surgical treatment is effective, but it is still associated with higher disability, prolonged hospital stays and mortality. Arterial embolization is recommended as an alternative to surgical intervention and more often replaces surgical in patients with severe comorbid background. Patients with this problem often belong to the elderly age group, which is associated with a severe comorbid background, and, therefore, a multidisciplinary approach to treatment is required. The treatment algorithm needs clear risk criteria and a structured treatment approach due to higher morbidity and mortality compared to conventional ulcerative bleeding. In addition, a promising approach of preventive embolization in peptic ulcer disease with a high risk requires further study.
About the Authors
V. V. Bedin
Botkin Hospital;
Russian Medical Academy of Postgraduate Professional Education, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Bedin Vladimir Vladimirovich – Doctor of medical Sciences, Professor of the Department of surgery; Deputy chief physician (surgical department)
125284, st. 2nd Botkinsky proezd, 5, Moscow
I. Yu. Korzheva
Botkin Hospital;
Russian Medical Academy of Postgraduate Professional Education, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Korzheva Irina Yur’evna – Doctor of medical Sciences. Head of the Department of endoscopy. Head of endoscopy department
125284, st. 2nd Botkinsky proezd, 5, Moscow
A. V. Vlasenko
Botkin Hospital;
Russian Medical Academy of Postgraduate Professional Education, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Vlasenko Aleksei Viktorovich – Doctor of medical Sciences, Professor of the Department of Anesthesiology, Intensive Care and Emergency Medicine. Head Department of Anesthesiology and Resuscitation № 32
125284, st. 2nd Botkinsky proezd, 5, Moscow
G. S. Mikhaylyants
Russian Medical Academy of Postgraduate Professional Education, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Mikhailyants Georgii Sergeevich – Doctor of medical Sciences, Professor of the Department of surgery
123242, Barrikadnaya street, 2/1, с1, Moscow
V. A. Turkan
Botkin Hospital
Russian Federation
Russian Federation
Tsurkan Vladimir Andreevich - radiologist of the Department of radiosurgical methods of diagnosis and treatment
125284, st. 2nd Botkinsky proezd, 5, Moscow
D. S. Bocharnikov
Botkin Hospital
Russian Federation
Russian Federation
Bocharnikov Dmitrii Stepanovich – Head of the Department of Emergency Surgical Care №75
125284, st. 2nd Botkinsky proezd, 5, Moscow
K. A. Sokolov
Botkin Hospital
Russian Federation
Russian Federation
Sokolov Kirill Anatolevich – surgeon of the Department of emergency surgical care №75
125284, st. 2nd Botkinsky proezd, 5, Moscow
References
1. Wang A., Yerxa J., Agarwal S. et al. Surgical management of peptic ulcer disease. Curr Probl Surg, 2020, № 57(2). https://doi.org/10.1016/j.cpsurg.2019.100728
2. Mille M., Engelhardt T., Stier A. Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers. Visc Med., 2021, № 37(1), рр. 52–62. https://doi.org/10.1159/000513689
3. Kavitt R.T., Lipowska A.M., Anyane-Yeboa A., Gralnek I.M. Diagnosis and Treatment of Peptic Ulcer Disease. American Journal of Medicine, 2019, № 132(4), рр. 447–456. https://doi.org/10.1016/j.amjmed.2018.12.009
4. Kempenich J.W., Sirinek K.R. Acid Peptic Disease. Surgical Clinics of North America, 2018, № 98(5), рр. 933–944. https://doi.org/10.1016/j.suc.2018.06.003
5. Vörhendi N., Soós A., Anne Engh M. et al. Accuracy of the Helicobacter pylori diagnostic tests in patients with peptic ulcer bleeding: a systematic review and network meta-analysis. Therap Adv Gastroenterol., 2020, № 13. https://doi.org/10.1177/1756284820965324
6. Kawai T., Oda K., Funao N. et al. Vonoprazan prevents low-dose aspirin-associated ulcer recurrence: Randomised phase 3 study. Gut., 2018, № 67(6), рр. 1033–1041. https://doi.org/10.1136/gutjnl-2017-314852
7. Yang H.J. Management of Peptic Ulcer Bleeding in Patients Taking Aspirin or Anticoagulant. Korean J Gastroenterol, 2020, № 76(5), рр. 242–245. https://doi.org/10.4166/kjg.2020.138
8. Tarasconi A., Coccolini F., Biffl W.L. et al. Perforated and bleeding peptic ulcer: WSES guidelines. World Journal of Emergency Surgery, 2020, № 15(1). https://doi.org/10.1186/s13017-019-0283-9
9. Ket S.N., Sparrow R.L., McQuilten Z.K., Gibson P.R., Brown G.J., Wood E.M. Critical peptic ulcer bleeding requiring massive blood transfusion: outcomes of 270 cases. Intern Med J., 2021, № 51(12), рр. 2042–2050. https://doi.org/10.1111/imj.15009
10. Dunne P.D.J., Laursen S.B., Laine L. et al. Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding. Clinical Gastroenterology and Hepatology, 2019, № 17(3), рр. 440–447.e2. https://doi.org/10.1016/j.cgh.2018.04.046
11. Barkun A.N., Almadi M., Kuipers E.J. et al. Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the international consensus group. Ann Intern Med., 2019, № 171(11), рр. 805–822. https://doi.org/10.7326/M19-1795
12. Sung J.J.Y., Chan F.K.L., Chen M. et al. Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding. Gut, 2011, № 60(9), рр. 1170–1177. https://doi.org/10.1136/gut.2010.230292
13. Lau J.Y.W., Yu Y., Tang R.S.Y. et al. Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding. New England Journal of Medicine, 2020, № 382(14), рр. 1299–1308. https://doi.org/10.1056/nejmoa1912484
14. Troland D., Stanley A. Endotherapy of Peptic Ulcer Bleeding. Gastrointest Endosc Clin N Am., 2018, № 28(3), рр. 277–289. https://doi.org/10.1016/j.giec.2018.02.002
15. Yu J.X., Russell W.A., Asokkumar R., Kaltenbach T., Soetikno R. Clipping Over the Scope for Recurrent Peptic Ulcer Bleeding is Cost-Effective as Compared to Standard Therapy: An Initial Assessment. Gastrointest Endosc Clin N Am., 2020, № 30(1), рр. 91–97. https://doi.org/10.1016/j.giec.2019.09.004
16. Stanley A.J., Laine L. Management of acute upper gastrointestinal bleeding. BMJ (Online), 2019, № 364. https://doi.org/10.1136/bmj.l536
17. Mullady D.K., Wang A.Y., Waschke K.A. AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review. Gastroenterology, 2020, № 159(3), рр. 1120–1128. https://doi.org/10.1053/j.gastro.2020.05.095
18. Kim J.S., Kim B.W., Park S.M. et al. Factors associated with rebleeding in patients with peptic ulcer bleeding: Analysis of the Korean peptic ulcer bleeding (K-PUB) study. Gut Liver, 2018, № 12(3), рр. 271–277. https://doi.org/10.5009/gnl17138
19. Yang E.H., Cheng H.C.., Wu CT., Chen W.Y., Lin M.Y., Sheu B.S. Peptic ulcer bleeding patients with Rockall scores ≥6 are at risk of longterm ulcer rebleeding: A 3,5-year prospective longitudinal study. Journal of Gastroenterology and Hepatology (Australia), 2018, № 33(1), рр. 156–163. https://doi.org/10.1111/jgh.13822
20. Bedin V., Korzheva I., Turkan V., Bocharnikov D., Sokolov K. Preventive X-ray endovascular arterial embolization in patients with ulcerative gastroduodenal bleeding with a high risk of recurrence. Moscow Surgical Journal. Published online 2023. (In Russ.) https://doi.org/10.17238/2072-3180-2023-1-50-56
21. Gralnek I.M. Be “routinely selective” when performing secondlook endoscopy in peptic ulcer bleeding! Gastrointest Endosc., 2018, № 87(2), рр. 466–468. https://doi.org/10.1016/j.gie.2017.10.024
22. Alhalabi M.M. Mortality and risk factors associated with peptic ulcer bleeding among adult inpatients of Damascus Hospital, Syria: A crosssectional study. Medicine (United States), 2023, № 102(17), рр. E33699. https://doi.org/10.1097/MD.0000000000033699
23. Loffroy R., Comby P.O., Falvo N. et al. Transcatheter arterial embolization versus surgery for uncontrolled peptic ulcer bleeding: Game is over. Quant Imaging Med Surg., 2019, № 9(2), рр. 144–145. https://doi.org/10.21037/qims.2019.02.01
24. Chevallier O, Falvo N, Midulla M, Loffroy R. Endoscopically unmanageable peptic ulcer bleeding: transcatheter arterial embolization remains the first-line therapy in 2020. European Journal of Trauma and Emergency Surgery, 2020, № 46(5), рр. 1037–1038. https://doi.org/10.1007/s00068-020-01442-w
25. Darmon I., Rebibo L., Diouf M. et al. Management of bleeding peptic duodenal ulcer refractory to endoscopic treatment: surgery or transcatheter arterial embolization as first-line therapy? A retrospective single-center study and systematic review. European Journal of Trauma and Emergency Surgery, 2020, № 46(5), рр. 1025–1035. https://doi.org/10.1007/s00068-020-01356-7
26. Sverdén E., Mattsson F., Lindström D., Sondén A., Lu Y., Lagergren J. Transcatheter Arterial Embolization Compared with Surgery for Uncontrolled Peptic Ulcer Bleeding: A Population-based Cohort Study. Ann Surg., 2019, № 269(2), рр. 304–309. https://doi.org/10.1097/SLA.0000000000002565
27. Kaminskis A., Ivanova P., Kratovska A. et al. Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience. World Journal of Emergency Surgery, 2019, № 14(1). https://doi.org/10.1186/s13017-019-0264-z
28. Lau J.Y.W., Pittayanon R., Wong K.T. et al. Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: A randomised controlled trial. Gut, 2018, № 1. https://doi.org/10.1136/gutjnl-2018-316074
Review
For citations:
Bedin V.V., Korzheva I.Yu., Vlasenko A.V., Mikhaylyants G.S., Turkan V.A., Bocharnikov D.S., Sokolov K.A. Bleeding gastroduodenal ulcer with a high risk of recurrence. Treatment tactics. Moscow Surgical Journal. 2025;(2):200-212. (In Russ.) https://doi.org/10.17238/2072-3180-2025-2-200-212
Views:
59
Email this article 