Transcatheter arterial embolization is the first-line therapy of choice in peptic ulcer bleeding not responding to endoscopic therapy

Abstract

Objective. In 5–10% of patients with peptic ulcer bleeding (PUB) it is impossible to achieve endoscopic hemostasis because of severe bleeding. These patients have traditionally been treated surgically. Transcatheter arterial embolization (TAE) may, however, be associated with a better outcome because of the less-invasive nature of the procedure. The aim of the present study was to identify the treatment of choice in endoscopy-refractory PUB. Materials and methods. A retrospective study. Consecutive patients treated with surgery or TAE for endoscopy-refractory PUB during a period of 16 years at a university hospital were included. Primary hemostasis, rebleeding rate, mortality, and complications were assessed. Mortality was compared between groups after adjustment for age, comorbidity, and anemia using logistic regression analyses. Comorbidity was quantified using the Charlson comorbidity index (CCI). Results. One hundred and eighteen patients were included. Patients treated with TAE had a higher CCI (mean: 2.33 vs 1.42; p = .003), and more severe anemia (mean: 6.8 vs 7.9 g/dl; p = .007) compared with patients treated with surgery. Surgery was associated with a higher rate of primary hemostasis (100% vs 91%; p = .007), lower rate of rebleeding (15% vs 40%; p = .004) but also higher rate of complications (60% vs 38%; p = .02) than TAE. Surgery was associated with an increased mortality (Odds ratio: 3.05; p = .033) when adjusting for confounding factors and excluding patients (n = 3) who were not candidates for both interventions. Conclusions. We propose use of TAE as first-line therapy in these patients as it may be associated with lower mortality and lower rate of complications compared with surgery.

Key Words:

• gastrointestinal bleeding
• surgery
• transcatheter arterial embolization

Acknowledgments

We acknowledge Professor Poul Erik Andersen, Department of radiology, Odense University Hospital, for his important work in performing the TAE-procedures. SB Laursen is the main writer of the manuscript and has performed the data analyses. MM Nielsen and M Jakobsen have scrutinized all patient records and been in charge of data registration. OB Schaffalitzky de Muckadell, MM Nielsen, M Jakobsen, SB Laursen, and C Hovendal have all been involved with the study design and data interpretation.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.