Ulcer Bleeding Research Articles

Prophylactic Proton Pump Inhibitors in Upper Gastrointestinal Bleeding: Impact and Underprescription in a French Multicentric Cohort.

Appropriate prescription of Proton pump inhibitors (PPIs) remains an important concern amid the rising overuse. A gap exists in the literature regarding the benefit of PPI prophylaxis and the consequences of underprescription in patients at risk for upper gastrointestinal bleeding (UGIB). This study aims to describe the characteristics of hemorrhage in relation to PPI use in patients experiencing UGIB, with a focus on high-risk individuals requiring gastroprotection. Data from a French multicentric cohort of patients experiencing UGIB were analyzed. Patients using PPI were compared to those without PPI considering bleeding etiologies and outcomes of peptic ulcer disease (PUD)-related hemorrhage. The rate of PPI use and its effect on bleeding characteristics in high-risk populations, defined based on international guidelines, were also assessed. Among 2497 included patients, 31.1% were on PPI at bleeding onset. PPI users exhibited a significantly lower rate of PUD-related bleeding in comparison with those without PPI (24.7 vs 40.8%, respectively, p < 0.0001). Similar difference was observed in high-risk populations, of whom, only 40.3% had gastroprotection with PPI before bleeding onset. PPI prophylaxis, however, did not influence the severity of bleeding in the general study population or in high-risk groups. Multivariate analysis identified age, comorbidities, and having more than two anti-thrombotic agents as predictors of severe bleeding. PPI users appear to have a lower rate of bleeding ulcers compared to non-users. However, underprescription in high-risk groups raises the need for standardized care to ensure appropriate PPI use.

S4030 Duodenal Ulcer and Gastrointestinal Bleeding as a Late Adverse Event of Over-The-Scope Clip (OTSC) Placement

S4030 Duodenal Ulcer and Gastrointestinal Bleeding as a Late Adverse Event of Over-The-Scope Clip (OTSC) Placement

Clinical Outcomes of Peptic Ulcer Bleeding

Despite advancements in endoscopic technology and drug therapy, the high mortality and rebleeding rates associated with hemorrhagic peptic ulcers remain a concern. Although further research is needed to validate contributing factors, I recommend use of the Rockall score to predict the rebleeding risk in patients with peptic ulcers. Greater caution should be exercised, particularly in hospitalized patients, those who have undergone pancreatic surgery, and those with bleeding due to Dieulafoy’s lesions. Delaying resumption of an oral diet for at least 24 hours after endoscopic bleeding control is also advisable.

S631 Esophageal Variceal Ligation Ulcer Bleeding: Outcomes of Different Modalities Used for Treatment

S631 Esophageal Variceal Ligation Ulcer Bleeding: Outcomes of Different Modalities Used for Treatment

TC-325 superiority in Malignant Gastrointestinal Bleeding - An Individual Patient Data Meta-analysis of Randomized Trials.

The efficacy of topical hemostatic agents, recommended for peptic ulcer bleeding, remains poorly characterized in malignant gastrointestinal bleeding (GIB). We performed an individual patient data (IPD) meta-analysis assessing the efficacy of topical hemostatic agents in malignant GIB. The literature was searched using OVID MEDLINE, EMBASE, and ISI Web of Sciencedatabases (database inception to November 2023). Only randomized controlled trials (RCTs) comparing topical hemostatic agents to conventional endoscopic modalities in malignant GIB were included. Original RCT patient-level data were obtained. PRISMA guidelines were followed. Quality of the evidence was evaluated using the revised Cochrane risk of bias tool, and certainty of evidence with the GRADE approach. The primary outcome was immediate hemostasis; secondary outcomes were 30-day rebleeding and the composite measure of further bleeding (persistent bleeding or 30-day rebleeding). Other outcomes were all-cause mortality, adverse events, and need for additional non-endoscopic treatment. Odds ratios (ORs) from endpoint comparisons were pooled using logistic regression models. Overall, 985 citations were identified; 3 RCTs (n=160 patients) were included with all assessing TC-325 (Hemospray™). TC-325 achieved immediate hemostasis more often than conventional endoscopic modalities (OR=46.6 (5.89; 369.1)) (low level certainty). Thirty-day rebleeding (OR=0.28 (0.11; 0.70)) and further bleeding (OR=0.11 (0.05; 0.26)) were both significantly lower with TC-325 (very low level certainty). All-cause mortality and need for additional non-endoscopic treatment did not differ between groups. No adverse events were reported. Subgroup analysis confirmed TC-325 superiority in patients with upper GIB. TC-325 appears superior to conventional endoscopic therapy in managing patients with malignant GIB. TC-325 results in improvements in immediate hemostasis, 30-day rebleeding and further bleeding, based on very low-to-low certainties of evidence.

General practice variation in peptic ulcer prophylaxis: a nationwide register-based study

Background Incidence of peptic ulcer bleeding can be substantially reduced by prophylactic use of proton pump inhibitors (PPIs) in patients at risk, but use of PPI varies among risk patients, and substantial under-prescribing may exist. The variation in prophylactic prescribing among general practices remains unknown. Methods A nationwide register-based cross-sectional study analyzing the proportion of patients at risk of ulcer bleeding receiving PPI treatment within Danish general practices. Using logistic regression, we analyze associations between general practice characteristics and prophylactic treatment among patients at risk of ulcer bleeding listed with the general practice. Results In most general practices, less than 40% of the patients at increased risk of ulcer bleeding were covered by PPI. Geographical variation was present, where practice location outside the capital area was associated with higher odds of PPI coverage among their risk patients. Partnership practices with GPs with a mean age ≥65 years or with only female GPs were associated with higher odds of providing prophylaxis among their risk patients compared to practices with a mean GP age <45 years or with only male GPs. Similar associations were not found for single-handed practices. Conclusions A significant under-prescribing of ulcer prophylaxis is common across all general practice characteristics, and only few associations with practice characteristics were present. Most efforts to rationalize PPI prescribing have aimed at reducing overprescribing but the findings point to under-prescribing as a problem as well. Development of new methods to assist GPs in identifying individuals at risk of ulcer complications is needed.

Bioresponsive and transformable coacervate actuated by intestinal peristalsis for targeted treatment of intestinal bleeding and inflammation

Developing an oral in situ-forming hydrogel that targets the inflamed intestine to suppress bleeding ulcers and alleviate intestinal inflammation is crucial for effectively treating ulcerative colitis (UC). Here, inspired by sandcastle worm adhesives, we proposed a water-immiscible coacervate (EMNs-gel) with a programmed coacervate-to-hydrogel transition at inflammatory sites composed of dopa-rich silk fibroin matrix containing embedded inflammation-responsive core-shell nanoparticles. Driven by intestinal peristalsis, the EMNs-gel can be actuated forward and immediately transform into a hydrogel once contacting with the inflamed intestine to yield strong tissue adhesion, resulting from matrix metalloproteinases (MMPs)-triggered release of Fe3+ from embedded nanoparticles and rearrangement of polymer network of EMNs-gel on inflamed intestine surfaces. Extensive in vitro experiments and in vivo UC models confirmed the preferential hydrogelation behavior of EMNs-gel to inflamed intestine surfaces, achieving highly effective hemostasis, and displaying an extended residence time (> 48 h). This innovative EMNs-gel provides a non-invasive solution that accurately suppresses severe bleeding and improves intestinal homeostasis in UC, showcasing great potential for clinical applications.

Impact of peptic ulcer bleeding on the in-hospital outcomes of cirrhotic patients with acute gastrointestinal bleeding: an international multicenter study

ABSTRACT Objectives Peptic ulcer is the most common source of non-variceal bleeding. However, it remains controversial whether the outcomes of cirrhotic patients with peptic ulcer bleeding differ from those with variceal bleeding. Methods Cirrhotic patients with acute gastrointestinal bleeding (AGIB) who underwent endoscopy and had an identifiable source of bleeding were retrospectively screened from an international multicenter cohort. Logistic regression analyses were performed to explore the impact of peptic ulcer bleeding on in-hospital death and 5-day failure to control bleeding. Propensity score matching (PSM) analysis was performed by matching age, gender, Child-Pugh score, and model for end-stage liver disease score between the peptic ulcer bleeding and variceal bleeding groups. Results Overall, 1535 patients were included, of whom 73 (4.7%) had peptic ulcer bleeding. Multivariate logistic regression analyses showed that peptic ulcer bleeding was not independently associated with in-hospital death (OR = 2.169, p = 0.126) or 5-day failure to control bleeding (OR = 1.230, p = 0.680). PSM analyses demonstrated that both in-hospital mortality (9.7% vs. 6.3%, p = 0.376) and rate of 5-day failure to control bleeding (6.9% vs. 5.4%, p = 0.787) were not significantly different between the two groups. Conclusions The impact of peptic ulcer bleeding on the in-hospital outcomes of cirrhotic patients is similar to that of variceal bleeding.

Tailoring Management of May-Thurner Syndrome : Case Comparison

Background: May-Thurner syndrome (MTS) is a post-thrombosis syndrome (PTS) of the lower extremity. This disorder results from compression and/or irritation from adjacent crossing the right common iliac artery to the left iliac venous. In this report, we present two management comparisons of patients with left lower DVT with consideration of MTS. Case Illustration: The first patient is a 49-year-old male soldier presented with chronic unilateral left leg edema and a mild clinical presentation for 9 months. Previous Doppler ultrasonography (DUS) revealed a thrombus in the left venous femoralis. Anticoagulant was given for six months. DUS and CT venography following anticoagulant treatment revealed a thrombus in the left venous femoralis. Venography revealed entire blockage of the left common femoral and left iliac veins, with adequate collateral flow. PTV was attempted twice and failed both times. The patient was following a conservative therapy (walking exercise and stocking compression) that yielded positive outcomes. The second patient is a 53-year-old male soldier has had unilateral left leg edema for three years, which has increased during the previous three months with ulceration and active bleeding. Previous Doppler ultrasonography revealed a thrombus in the left iliac externa. Anticoagulants and compression stockings were given for eight months, but the symptoms persisted. CT and venography revealed a complete blockage from the left popliteal vein to the iliac vein. Femoral crossover bypass surgery yielded favorable results. Conclusion: Clinically moderate MTS demonstrated fair results with conservative treatment, whereas clinically severe MTS showed superior results with bypass surgery. Keyword: Anticoagulant, May-Thurner Syndrome, Palma Procedure.

Radiosensitization treatment using hydrogen peroxide for inoperable rectal cancer.

The treatment outcomes of patients with unresectable rectal cancer are complex, and concurrent chemoradiation therapy is the main treatment option. Radiosensitizers can enhance the effect of localized intratumoral hypoxia, contributing to local control and symptomatic relief. The present study evaluated the feasibility and safety of radiosensitization using hydrogen peroxide combined with radiation therapy (RT) in patients with unresectable rectal cancer. A total of 13 patients with rectal cancer were recruited in the present study. Radiosensitization was performed twice weekly in combination with RT. Gauze soaked in 3% hydrogen peroxide solution was inserted into the anus, ensuring firm contact with the lesion. In total, 45-65 Gy was delivered in 25-33 fractions to the whole pelvis from four directions using 10 MV X-rays 5 days per week. Acute and late adverse events were evaluated 1 and 6 months after the completion of RT. Treatment was well tolerated, with no acute grade 3 or worse events noted, and no patient developed rectal fistula, necrosis, obstruction, perforation, stenosis, ulcer or retroperitoneal hemorrhage. No notable late adverse events, beyond 6 months, were observed at the end of the analysis. All patients experienced pain relief, hemostatic effects and tumor shrinkage. Therefore, the use of a hydrogen peroxide solution-soaked gauze in the rectum may be a promising option for patients with inoperable rectal tumors. The limitations of the present study are that the patient population was small and the observation time was relatively short. This study was retrospectively registered with the University Hospital Medical Information Network Center (trial registration no. R000061902) on April 21, 2024.

Transcatheter embolization for duodenal ulcer bleeding originating from cystic artery erosion

BackgroundUlcer erosion into the cystic artery is a rare cause of bleeding in duodenal ulcers, with only a limited number of cases described in the literature. Historically, treatment has predominantly involved surgical intervention. We present three cases of duodenal ulcer bleeding due to cystic artery erosion, which were successfully managed with cystic artery embolization.Case presentationThis case series includes three male patients with duodenal ulcer bleeding, aged 90, 81, and 82 years, respectively, and no prior history of biliary system disorders. The ulcer locations were identified as two in the post-bulbar region and one in the anterior bulb. After the failure of medical and endoscopic treatment, transcatheter arterial embolization was adopted. Initial angiography did not reveal any contrast medium extravasation. Empirical embolization of the gastroduodenal artery using gelatin sponge particles and coils failed to achieve hemostasis. Super-selective cystic artery angiography confirmed the source of bleeding as the cystic artery. One patient was embolized with gelatin sponge particles and coils, while the other two patients were embolized with N-butyl-cyanoacrylate. All patients achieved successful hemostasis without gallbladder infraction.ConclusionsCystic artery embolization proved to be a minimally invasive technique for achieving hemostasis in these cases, indicating that it may be a safe and effective alternative to surgery for this uncommon cause of upper gastrointestinal bleeding. Validation through further studies is warranted.

Calibre Persistent Labial Artery of the Lower Lip: Oral Propranolol as a Novel Agent of Treatment

Abstract Calibre persistent artery of the lower lip is a vascular anomaly where the branches of the inferior labial artery maintain their size up to the submucosa of the lip. There is persistent pulsatile feeling, occasional ulceration, and recurrent bleeding. Doppler ultrasound and angiogram are used to confirm diagnosis. Before this case report, treatment of this condition has been surgical excision. We document the successful treatment with oral propranolol.

Ideal strategy for nonvariceal upper gastrointestinal bleeding.

Over 300 000 hospital admissions in the United States each year are due to patients with upper gastrointestinal (GI) bleeding (UGIB). Common etiologies of nonvariceal UGIB include peptic ulcers, mucosal erosions of the esophagus, stomach or duodenum, Mallory-Weiss tears, Dieulafoy lesions, upper GI tract malignancy, or other etiology. Peptic ulcers classified as Forrest Ia, Ib, or IIa require endoscopic hemostasis, while IIb ulcers may be considered for endoscopic clot removal with endoscopic treatment of any underlying major stigmata. Endoscopic hemostasis for ulcers classified as Forrest IIc or III is not advised due to the low risk of recurrent bleeding. Endoscopic hemostasis in ulcer bleeding can be achieved using injection, thermal, and/or mechanical modalities. This review focuses on the currently recommended endoscopic therapies of patients presenting with acute nonvariceal upper gastrointestinal hemorrhage.

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: is it suitable for all?

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: is it suitable for all?

Efficacy of Vonoprazan vs. Intravenous Proton Pump Inhibitor in Prevention of Re-Bleeding of High-Risk Peptic Ulcers: A Randomized Controlled Pilot Study.

Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to evaluate the comparative efficacy of intravenous PPI infusion versus VPZ in preventing re-bleeding after endoscopic hemostasis in patients with high-risk peptic ulcers. Methods: A randomized, double-blind, controlled, and double-dummy design was employed. Patients with peptic ulcer bleeding (Forrest class IA/IB or IIA/IIB) who underwent endoscopic hemostasis were randomly assigned to either the PPI group or the VPZ group. Re-bleeding rates at 3, 7, and 30 days, the number of blood transfusions required, length of hospitalization, and ulcer healing rate at 56 days were assessed. Results: A total of 44 eligible patients were enrolled, including 20 patients (PPI group, n = 11; VPZ group, n = 9) with high-risk peptic ulcers. The mean age was 66 years, with 70% being male. Re-bleeding within 72 h occurred in 9.1% of the PPI group versus 0% in the VPZ group (p = 1.000). There was no significant difference in re-bleeding rates within 7 days and 30 days (18.2% vs. 11.1%, p = 1.000). Additionally, the ulcer healing rate did not significantly differ between the groups (87.5% vs. 77.8%). Conclusions: This pilot study demonstrates comparable efficacy between oral vonoprazan and continuous PPI infusion in preventing recurrent bleeding events among high-risk peptic ulcer patients following successful endoscopic hemostasis.

Polypoid non-neural granular cell tumor of the oral cavity

Aim: To report a case of non-neural granular cell tumor (NN-GCT), an uncommon neoplasm, with only six studies worldwide describing cases involving the oral cavity. Methods: A 26-year-old male patient with an erythematous, firm, polypoid nodule in the floor of the mouth that exhibited areas of ulceration and mild bleeding to the touch. A biopsy was performed to aid in the diagnosis. Results: Based on the histopathological and immunohistochemical results (vimentin +, CD68 +, S100 -), the diagnosis was compatible with S100-negative (primitive polypoid non-neural) granular cell tumor. No recurrence was observed over two years of follow-up. Conclusion: The diagnosis of NN-GCT is extremely challenging because this tumor shares histological and immunophenotypic features with many benign and malignant tumors. Although oral NN-GCT may exhibit unusual and atypical histological features, it has an indolent behavior. Thus, until more cases of oral involvement are reported, complete resection and close follow-up are recommended.

Phellodendron chinense C.K.Schneid: An in vitro study on its anti-Helicobacter pylori effect

Ethnopharmacological relevancePhellodendron chinense C.K.Schneid(P. chinense Schneid) is known in TCM as Huang Bo, is traditionally used to support gastrointestinal function and alleviate stomach-related ailments, including gastric ulcer bleeding and symptoms of gastroesophageal reflux disease. Helicobacter pylori (H. pylori) is classified by the WHO as a Group 1 carcinogen. However, the specific activity and mechanism of action of P. chinense Schneid against H. pylori infection remain unclear. It has been noted that Huangjiu processing may alter the bitter and cold properties of P. chinense Schneid, but its effect on antimicrobial activity requires further investigation. Additionally, it remains uncertain whether berberine is the sole antimicrobial active component of P. chinense Schneid. Aim of studyThis study aims to elucidate the anti-H. pylori infection activity of P. chinense Schneid, along with its mechanism of action and key antimicrobial active components. Materials and methodsPhytochemical analysis was carried out by UPLC-MS/MS. HPLC was employed to quantify the berberine content of the extracts. Antimicrobial activity was assessed using the micro broth dilution method. Morphology was observed using SEM. The impact on urease activity was analyzed through in vitro urease enzyme kinetics. RT-qPCR was employed to detect the expression of virulence genes, including adhesin, flagellum, urease, and cytotoxin-related genes. The adhesion effect was evaluated by immunofluorescence staining and agar culture. ResultsP. chinense Schneid exhibited strong antimicrobial activity against both antibiotic-sensitive and resistant H. pylori strains, with MIC ranging from 40 to 160 μg/mL. Combination with amoxicillin, metronidazole, levofloxacin, and clarithromycin did not result in antagonistic effects. P. chinense Schneid induced alterations in bacterial morphology and structure, downregulated the expression of various virulence genes, and inhibited urease enzyme activity. In co-infection systems, P. chinense Schneid significantly attenuated H. pylori adhesion and urease relative content, thereby mitigating cellular damage caused by infection. Huangjiu processing enhanced the anti-H. pylori activity of P. chinense Schneid. Besides berberine, P. chinense Schneid contained seven other components with anti-H. pylori activity, with palmatine exhibiting the strongest activity, followed by jatrorrhizine. ConclusionsThis study sheds light on the potential therapeutic mechanisms of P. chinense Schneid against H. pylori infection, demonstrating its capacity to disrupt bacterial structure, inhibit urease activity, suppress virulence gene transcription, inhibit adhesion, and protect host cells. The anti-H. pylori activity of P. chinense Schneid was potentiated by Huangjiu processing, and additional components beyond berberine were identified as possessing strong anti-H. pylori activity. Notably, jatrorrhizine, a core component of P. chinense Schneid, exhibited significant anti-H. pylori activity, marking a groundbreaking discovery.

Risk factors and outcomes of peptic ulcer bleed in a Pakistani population: A single-center observational study

BACKGROUND Peptic ulcer disease (PUD) remains a significant healthcare burden, contributing to morbidity and mortality worldwide. Despite advancements in therapies, its prevalence persists, particularly in regions with widespread nonsteroidal anti-inflammatory drugs (NSAIDs) use and Helicobacter pylori infection. AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal (GI) bleeding in Pakistani population. METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022. Data on demographics, symptoms, length of stay, mortality, re-bleed, and Forrest classification was collected. RESULTS The mean age of patients was 53 years, and the majority was men (68.3%). Hematemesis (82.4%) and epigastric pain (75.4%) were the most common presenting symptoms. Most patients (73.2%) were discharged within five days. The mortality rates at one week and one month were 10.6% and 14.8%, respectively. Re-bleed within 24 h and seven days occurred in 14.1% and 18.3% of patients, respectively. Most ulcers were Forrest class (FC) III (72.5%). Antiplatelet use was associated with higher mortality at 7 and 30 d, while alternative medications were linked to higher 24-hour re-bleed rates. NSAID use was associated with more FC III ulcers. Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality. CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding, while alternative medicines are associated with early rebleeding.

#3051 Light chain only variant of proliferative glomerulonephritis with monoclonal immunoglobulin deposits: a case report

Abstract Background and Aims Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is an entity characterized by glomerular deposition of monoclonal immunoglobulins, typically IgG. Recently, a cohort of 17 patients presenting with light chain only variant of PGNMID was published. Strikingly, in this cohort, glomerular deposition of C3 was detected in all cases. We herein report a case of PGNMID with a rare presentation on the kidney biopsy. Case presentation We present the case of a 73-year-old female with a past medical history of rheumatoid arthritis and hypertension, under methotrexate 10 mg per week, prednisone 2.5 mg per day, amlodipine, nebivolol, azilsartan, and a recurrent naproxen intake. She presented with fatigue, anorexia, weight loss of about 12% of her body weight, epistaxis, oral bleeding ulcers, and lower extremities oedema. Pancytopenia, acute kidney injury (urea 150 mg/dL, creatinine 2.92 mg/dL), and nephrotic syndrome (serum albumin of 2.7 mg/dL and proteinuria of 12 g/day) were noted. Further evaluation showed an imbalance of the free light chains’ ratio with kappa light chain's level of 1250 mg/dL. Serum protein electrophoresis and immunofixation were normal. A CT scan showed numerous cervical, mediastinal, and iliac enlarged lymph nodes. Kidney biopsy showed an increase in mesangial cells and matrix and capillary walls’ thickening without nodular lesions under a light microscope. Immunofluorescence microscopy showed granular deposits of kappa light chains and no deposition IgA, IgG, IgM, C1q, C3, fibrin and lambda. Considering the previous literature, C3 was reanalyzed, with a consistent negative staining. Based on the above findings, a diagnosis of Light chain only variant of PGNMID was made. Concomitantly, evaluation of the bone marrow sample showed Small lymphocytic lymphoma. The patient was started on Bortezomib, cyclophosphamide and dexamethasone. Three months after proteinuria was 0.47 g/g and creatinine 1.7 mg/dL. Conclusion This case highlights the rare occurrence of a PGNMID with light chains only deposition (without C3 co-deposition) as a complication of small lymphocytic lymphoma. This contributes to the growing body of evidence surrounding this entity, with the particularity being that C3 was not detected. The authors hypothesized some pathophysiologic mechanisms to justify the absence of C3 co-deposition.

IMMEDIATE RESULTS OF MINIMALLY INVASIVE SURGERY FOR COMPLICATED PEPTIC ULCERS OF THE STOMACH AND DUODENUM

Objective: To enhance the immediate treatment outcomes of complicated peptic ulcers of the stomach and duodenum through the development and application of video-assisted organ-preserving surgeries. Materials and Methods: This study analyzed the treatment outcomes of 261 patients with complicated gastric and duodenal ulcers. The patients received the treatment in the surgical departments of Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev, Scientific Surgical Center named after M.A. Topchubashev, and Sabunchi Medical Center from 2015 to 2023. All patients with perforated and bleeding ulcers of the stomach and duodenum underwent clinical and instrumental examinations. The initial general condition of the patient was thoroughly assessed. Among the patients, there were 220 men (84.3%) and 41 women (15.7%), with ages ranging from 18 to 84 years. There were 75 (28.7%) patients complicated with bleeding of gastric and duodenal ulcer, and 186 (71.3%) patients with perforation. In the control group, traditional, "open" surgical interventions were performed in 164 (62.8%) patients, and minimally invasive endoscopic video-assisted operations were performed in 97 (37.2%) cases. Out of 186 patients, 124 (66.7%) underwent traditional suturing of a perforated gastroduodenal ulcer during laparotomy, while 62 (33.3%) underwent minimally invasive endosurgical interventions. In the control group, 12 (8.4%) patients underwent gastric resection, and 10 (5.4%) underwent vagotomy with pyloroplasty. The immediate results of radical operations for a perforated ulcer were characterized by a high percentage of early complications, with 5 (41.6%) cases. Results. Of the 186 patients operated on for perforated gastroduodenal ulcer, 12 individuals (6.5±2.9%) developed complications in the postoperative period: 9 (7.3%) in the comparison group, and 3 (4.8%) patients in the main group. We obtained a statistically significant shorter duration of a surgical intervention by 24.8 minutes and shorter hospital staying time due to a decrease in the duration of the postoperative period by 5.3 days, a lower number of postoperative complications by 2.5%, and a lower postoperative mortality by 2.4%. The duration of laparoscopic suturing of a perforated ulcer averaged 38.6 minutes. The duration of hospital staying averaged 6.9±1.2 days. The use of minimally invasive interventions for ulcerative duodenal bleeding was accompanied by a significant reduction in the rehabilitation period compared with that after traditional, "open" operations that amounted to 18.3+3.6 and 35.5±5.9 days, respectively. Postoperative mortality was 1.3% (1 patient in the control group died). Conclusion. The outcome of treatment depends on the age of patients, the timing of the onset of the disease, the severity of concomitant pathology, the severity and extent of peritonitis and the duration of ulcerative anamnesis.