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Jon S. Thompson, MD
Omaha, Neb

Arch Surg. 2003;138:762.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

As pointed out by Camprodon et al, juxtacardial or type IV gastric ulcers occur infrequently. Although they do not describe the incidence, Camprodon et al reported 8 patients from a 6-year period. Ulcers in this location occur in the elderly, are usually large, are potentially malignant, and frequently present with bleeding or perforation. Their patients were elderly and presented emergently. This combination of factors makes the bleeding juxtacardial ulcer a clinical challenge.

Three issues are raised by the authors in their introductory comments. Does endoscopic control of bleeding eliminate the need for operation? What is the best surgical option? What is the optimal timing of surgical intervention?

Given the high-risk nature of these patients, endoscopic therapy has great appeal. Camprodon et al found that the bleeding site was visualized in 5 of 8 patients and the bleeding controlled in 3. However, they elected to proceed with . . . [Full Text of this Article]

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Transgastric Surgery for Posterior Juxtacardial Ulcers: A Minimal and Safe Approach
Ricardo A. M. Camprodon, Reyad Al-Ghnaniem, and Ricard Camprodon
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