Investigation of the Indications for Conservative Therapy to Treat Perforated Gastroduodenal Ulcers

Abstract

At our hospital, we have been using the criteria reported by Watanabe et al. to determine the treatment plan for patients with of perforated gastroduodenal ulcers to determine whether they should undergo surgery. Between April 2003 and March 2015, we evaluated 117 cases of perforation, and among these, we selected conservative treatment for 14 cases. One of these 14 cases required conversion to surgery. Although we selected surgical treatment in 103 cases, at surgery, the perforation was already covered in 19 cases. The Watanabe score was found to have a sensitivity of 0.99 and specificity of 0.41, and none of the cases judged using this scoring method had perforation as a cause of death. We have therefore determined the validity of the Watanabe score. However, we believe that we performed an excessive amount of surgery as we found some cases in which the perforation was already covered and therefore could have been managed conservatively. To avoid this, we have proposed the following new scoring system, which uses coefficients to provide weighting during logistic regression analysis for the four items found to have a significant difference in terms of their Watanabe scores. The formula is calculated as: 0.36 + 1.29 [if symptoms of peritoneal irritation are limited to the epigastrium] + 0.92 [if no severe concomitant disease] + 0.80 [if duration is less than 6 hours from the time of onset to initial examination] + 0.63 [if progression of ascites is limited to the epigastrium]. If the total score is 2.08 or greater, then conservative treatment is selected. This new scoring system not only decreases the number of items evaluated when compared to the Watanabe system, but with a sensitivity of 0.94 and specificity of 0.63, it may also provide a more definitive method for determining the treatment plan.