Background: Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment. Summary: This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined. Key Messages: Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.
Visc Med

中文翻译：

---

十二指肠溃疡出血：高危溃疡的治疗策略


背景：急性消化性溃疡出血仍然是入院的主要原因。特别是十二指肠溃疡出血的治疗需要结构化的治疗方法，因为与胃溃疡相比，其发病率和死亡率更高。患有这些出血性溃疡的患者往往处于高危状态，需要多学科治疗。摘要：本综述为十二指肠溃疡出血的现代治疗提供了结构化方法，并阐明了高风险情况下的治疗实践。回顾了初始治疗，包括药物治疗、风险分层、内窥镜检查、手术和经导管动脉栓塞，并严格讨论了它们在十二指肠溃疡出血治疗中的作用。此外，还概述了预防性治疗方法的未来前景。关键信息：除了药物治疗和内窥镜的进步之外，高危十二指肠溃疡的出血管理仍然是一个挑战。当出血持续存在或发生再出血并且金标准内窥镜检查失败时，需要进行手术和放射治疗来控制溃疡出血。进行外科手术是为了控制出血，但它们仍然会导致较高的发病率和较长的住院时间。与此同时，经导管动脉栓塞被推荐作为手术的替代方案，并且更常替代手术治疗内镜止血失败的情况。未来的研究需要改进风险分层，从而更好地选择高风险溃疡和最佳治疗。 此外，必须进一步研究高危十二指肠溃疡预防性栓塞的有前途的方法，以减少再出血并改善这些患者的预后。
 内脏医学