Retrospective study of 189 cases of acute perforated peptic ulcer: safety and efficacy of over-the-scope-clip based endoscopic closure.

Autor: You WJ; Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China., Lian TT; Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China., Qian O; Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China., Wei JJ; Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China., Zhuang ZH; Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China. zhuang203@yeah.net.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Aug; Vol. 38 (8), pp. 4374-4379. Date of Electronic Publication: 2024 Jun 17.
DOI: 10.1007/s00464-024-10982-w
Abstrakt: Background: To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure.
Methods: Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis.
Results: Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4-23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24 h (median [IQR] time: 14.5 [7.00-30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87 mm ± 5.97 mm and 8.55 mm ± 6.17 mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00-12.25] days) and non-surgical group (9.00[7.00-13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00-16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00-10.00]) than in the non-surgical group (9.00[7.00-11.00]) and surgical group (11.00[9.00-13.00]) ( p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00-5.25]) than in the non-surgical group (7.00[6.13-9.00]) and surgical group (8.00[6.53-10.00]), respectively ( p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687-0.993), 1.077 (1.005-1.154), and 1.025 (1.006-1.043), respectively (all p < 0.05).
Conclusion: OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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