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Transarterial embolization is a safe, nonoperative option for acute peptic ulcer bleeding
Date:5/23/2011

, we set out to compare the outcomes of transarterial embolization and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed," said study lead author Tiffany Cho-Lam Wong, The Institute of Digestive Disease, The Chinese University Hong Kong. "We found TAE is a safe procedure with a high technical success rate. In those with gastroduodenal ulcer bleeding in whom endoscopic hemostasis failed, TAE reduces the need for surgery and the overall complications, and accomplishes this without increasing the overall mortality."

Methods

This was a retrospective study of patients admitted to the Prince of Wales Hospital at the Chinese University of Hong Kong. Data were retrieved from a prospectively-collected GI bleeding registry. Consecutive patients admitted with overt signs of upper GI bleeding received endoscopy within 24 hours after admission. Patients were under the joint care of surgeons and gastroenterologists. "Salvage" intervention (either surgery or TAE) was deemed to be warranted if active bleeding could not be controlled by endoscopic means or if a patient had a second rebleeding episode. The main outcomes measurements were all-cause mortality, rebleeding, reintervention, and complication rate.

Results

Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were the gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation (blood flowing from a vessel into surrounding tissue) was seen in 15 patients (46.9 percent). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5 percent). Bleeding recurred in 11 patients (34.4 percent) in the TAE group and in 7 patients (12.5 percent) in the surgery group. More complications were observed in patients who underwent surgery (40.6 percent vs. 67.9 percent).
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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