Upper GI bleed: no clear benefit from immediate elective surgery

Clinical bottom line (level 4)

  1. Patients with nonvariceal upper GI bleeding who had immediate surgery compared with surgery only in an emergency were not clearly less likely to die.
Wong et al: Australian and New Zealand Journal of Surgery 1980; 50 (2): 150-154
Expires October 2002

The study

Retrospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.
Setting: university hospital, Hong Kong

0 patients (aged mean ~65, 69% male) acute non-variceal GI bleed (from peptic ulcers, malignancy or gastritis)

Excluded if
  • aged < 50


    • Control Group: (n = 161, 161 analysed): conventional treatment: retrospective control group-patients who were admitted 4 years previously and who had surgery if they had a massive bleed or continued to bleed despite endoscopy, otherwise supportive care
    Experimental Group: (n = 123, 123 analysed): immediate surgery: endoscopy within 6 hours of admission followed by surgery

    100% followed for ? ?hospital stay to discharge

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death unknown 19
    (11.8%)    		 14
    (11.4%)    		 4%
    (-85% to 50%)    		 0.42%
    (-7.09% to 7.93%)    		 240
    (NNT = 13 to infinity;
    NNH = 14 to infinity)

    Comments

    1. Therapy has changed since 1980 when this study was done (including the use of H2 blockers and omeprazole) and surgery is rarely performed now in these patients
    2. Not adjusted for potential confounders like co-morbidity, age, type of surgical procedure
    3. Surgical techniques different from those commonly in use today

    Citation

    1. Wong J, Lam SK, Lee NW: immediate operation for acute non-variceal gastrointestinal haemorrhage in patients aged 50 years and over. Australian and New Zealand Journal of Surgery 1980; 50 (2): 150-154
    Contributor: Sharon Straus and Chris Ball, October 1999
    Reviewer:

    Clinical Question.
    Patient non-variceal upper GI bleed
    Intervention or Exposure immediate surgery
    Comparison surgery only if an emergency
    Outcome death