Clinical feature and treatment of bleeding from remnant stomach after subtotal gastrectomy

Objective 　To explore the clinical feature and effective method of treatment for upper gastrointestinal bleeding from remnant stomach. Methods 　Seventy-one patients with remnant stomach suffering from upper gastrointestinal bleeding as confirmed by gastroscopy were admitted to Qingdao Municipal Hospital from January 2005 to January 2015. Kruskal Wallis test was used to compare the separate multiple sets of ordered categorical data. Results 　Remnant stomach complicated by upper gastrointestinal bleeding was more common in males than females (83.01% vs 16.9%), and in elder patients (53/71, 74.6%), accompanied by tarry stool (47/71, 66.4%), undergoing subtotal gastrectomy over 5 years (63.4%, 45/71), and the procedure was Billroth Ⅱ subtotal gastrectomy (71.8%, 51/71). The differences in cause of bleeding were statistically different among younger, middle-aged and older groups (H=24.354, P＜0.001), and the most common cause of bleeding was marginal ulcer. There were statistical differences in degree of bleeding, Forrest classification, and treatment methods (H=16.319, P=0.005; H=18.681, P=0.003; H=14.226, P=0.009) between patients with mild, moderate and severe condition. The efficacy rate for conservative medical treatment was 93.0% (66/71). The success rate of endoscopic hemostasis was 83.3% (15/18). Conclusions 　Male, old age, longer than 5 years postoperation, and Billroth Ⅱ gastrectomy are high-risk factors for bleeding in the patients undergone subtotal gastrectomy. The comprehensive treatment with drugs, endoscopic hemostasis and surgical treatment are essential in rescuing critical patients. DOI: 10.11855/j.issn.0577-7402.2016.01.08