Role of Intraoperative Biopsy and Postoperative Upper Gastrointestinal Endoscopy in Patients Undergoing Surgery for Perforated Gastric Ulcer: A Retrospective Study.

Introduction The intraoperative biopsy of a perforated gastric ulcer is a common practice; however, it may prove to be therapeutically futile, as an upper gastrointestinal endoscopy (UGE) is indicated regardless of the result. Objective To evaluate the histology of the perforated gastric ulcer biopsy (PGUB) and its effect on the subsequent clinical course. Methods A retrospective study (May 2017 to June 2024) of patients diagnosed with perforated gastric ulcer (K251 and K255 - ICD-10), with a review of medical records in the Medical Support System, was conducted. The histology of the PGUB, the performance of UGE, the degree of concordance between the histology of both, and the potential waiver of UGE were evaluated. Informed consent was waived, as this is an observational study without any interference with clinical conduct. Results During the evaluation period, 21 patients underwent PGUB, and 19 patients had a benign histological result; one patient was diagnosed with high-grade non-Hodgkin lymphoma, and one patient had gastric adenocarcinoma. In the following period, 10 patients underwent UGE, and in none of them did the histological diagnosis change. Of the remaining 11 patients who did not undergo UGE, five died, one was lost to follow-up, three are awaiting the procedure, and only two did not undergo the endoscopic exam. Conclusion The intraoperative biopsy of a perforated gastric ulcer is possibly futile, as it does not alter the clinical course. Regardless of the histological result obtained, a UGE is requested.