Is Intraoperative Biopsy Necessary for Gastric Ulcer Perforation? Systematic Review

Introduction: Gastric ulcer perforation is a vital surgical emergency requiring rapid intervention. In this case, intraoperative biopsy is generally performed to detect possible malignancy risk (historical data says 9–23% gastric cancer positivity). Objective: To evaluate the necessity of intraoperative biopsy in gastric ulcer perforations by current biopsy proven malignancy rates and its effect on complications. Methods: This systematic review conducted in accordance with the PRISMA guidelines. Studies involving adult patients who underwent surgery due to gastric ulcer perforation were examined. The main evaluation criterion was the malignancy detection rate. Data of appropriate studies were analyzed with fixed and random effects models. Results: From twelve studies, the gastric cancer rate was only 3.3% in 953 patients who underwent intraoperative biopsy (95% CI: 1.46%-5.95%). One study observed that postoperative complications significantly increase in patients undergoing biopsy. Conclusion: We do not recommend intraoperative biopsy for gastric ulcer perforations. Current cancer frequency in gastric ulcer perforations is much less than previously reported. Additionally, gastric cancer treatment protocols have changed today, and intraoperative biopsy may increase complications. Primary repair and postoperative planned endoscopy should be preferred. Cancer diagnosed patients with postoperative endoscopic biopsies should be re-evaluated for radical surgery following neoadjuvant chemotherapy.