Therapy

Consider surgery for patients who have evidence of ^d

• persistent haemorrhage despite endoscopic therapy
• recurrent haemorrhage despite endoscopic therapy

• A more aggressive policy leads to more surgery, but does not clearly save lives ^d

• A partial gastrectomy prevents rebleeding and reoperation more effectively than oversewing and a vagotomy for patients with bleeding duodenal ulcers, but leads to more duodenal leaks. ^b
• There is no clear effect on mortality. ^b

Partial gastrectomy reduces rebleeding and reoperations better than oversewing and vagotomy

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
bleeding duodenal ulcer b	partial gastrectomy	oversewing and vagotomy	rebleeding at 4 weeks	17%	81% (16% to 96%)	7 (4 to 31)
			reoperations at 4 weeks	14%	88% (6% to 98%)	8 (5 to 37)
			duodenal leaks at 4 weeks	3.5%	-290% (-1600% to 14%)	-10 (-1200 to -5)