Of 796 patients admitted with upper gastrointestinal bleeding during a five-year period, 156 (20%) had erosive gastritis. Vigorous nonoperative treatment stopped bleeding in 117 (75%): emergency operation was required in 39 (25%). In 24 of these 39 patients (group A), subtotal gastric resection with truncal vagotomy was performed. In the remaining 15 patients (group B), the operation was limited to pyloroplasty, truncal vagotomy, and multiple suture ligation. These patients were, on the average, 20 years older than the patients in group A, and 12 had life-threatening preoperative problems. (Only four of the group A patients had life-threatening preoperative problems.) The operative mortality in group A was 42%, with rebleeding occurring in 33%. In group B, only 17% rebled and the operative mortality was 45%.
Survival in the two groups was similar, even though those patients in group B were more critically ill. The less radical procedure may often be the best choice in the high-risk and elderly patients who bleed massively and in whom immediate salvage of life is the main issue.