Excisional biopsy of perforated gastric ulcer: mandatory or potentially harmful?

Langenbecks Arch Surg. 2024 Jul 4;409(1):205. doi: 10.1007/s00423-024-03393-x.

Abstract

Purpose: This study aimed to evaluate the morbidity associated with excisional biopsy in patients with spontaneous gastric perforation.

Methods: A retrospective, single-center, observational study was performed. All consecutive patients with spontaneous gastric perforation who underwent surgical therapy were included. Outcomes were assessed concerning the performance of excisional biopsy.

Results: A total of 135 adult patients were enrolled. Of these, 110 (81.5%) patients underwent excisional biopsy, while 17 (12.6%) did not. The remaining eight (5.9%) patients who underwent gastric resection were excluded from the analysis. Patients undergoing excisional biopsy developed significantly higher rates of postoperative complications (p = 0.007) and experienced more severe complications according to the Clavien-Dindo classification, particularly type III and above (p = 0.017). However, no significant differences were observed regarding in-hospital mortality, reoperation, suture dehiscence, or length of hospital stay.

Conclusion: Excisional biopsy for gastric perforation has been shown to be associated with increased morbidity. Surgical closure followed by early endoscopic biopsy may be a superior approach for gastric perforation management to rule out malignancy.

Keywords: Gastric cancer; Peptic ulcer; Spontaneous gastric perforation; Ulcer excision.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer Perforation* / mortality
  • Peptic Ulcer Perforation* / pathology
  • Peptic Ulcer Perforation* / surgery
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Stomach Ulcer* / pathology
  • Stomach Ulcer* / surgery