Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure.
OBJECTIVE
To compare the outcomes of embolotherapy and surgery as salvage therapy after therapeutic endoscopy failure in the treatment of upper gastrointestinal peptic ulcer bleeding.


METHODS
Retrospective analysis of 70 cases of refractory peptic upper gastrointestinal hemorrhage was performed. Thirty-one cases were managed with embolotherapy and 39 were managed surgically. Demographic variables, underlying conditions, clinical findings, endoscopic treatment, transfusion requirements before and after alternative therapeutic approach, length of hospital stay, and outcomes including recurrent bleeding, need for surgery after initial alternative treatment, and in-hospital death were recorded.


RESULTS
Patients who received embolotherapy were older (75.2 years +/- 10.9 vs 63.3 years +/- 14.5; P <.001) and had greater incidences of heart disease (67.7% vs 20.5%; P <.001) and previous anticoagulation treatment (25.8% vs 5.1%; P =.018). There were no differences in the rest of the pretreatment variables. No differences were found between the embolotherapy and surgery groups in the incidence of recurrent bleeding (29% vs 23.1%), need for additional surgery (16.1% vs 30.8%), or death (25.8% vs 20.5).


CONCLUSIONS
The lack of differences between these two treatment alternatives, despite the more advanced age and greater prevalence of heart disease in the embolotherapy group, provides support for future prospective randomized studies aimed to evaluate the role of embolotherapy in the management of refractory peptic ulcer bleeding.
Ripoll
Cristina
C
Departments of Gastroenterology and Hepatology, Hospital General Universitario Gregorio Marañón, C/Dr Esquerdo 46, 28007 Madrid, Spain.
Bañares
Rafael
R
Beceiro
Inmaculada
I
Menchén
Pedro
P
Catalina
María-Vega
MV
Echenagusia
Antonio
A
Turegano
Fernando
F
D017677:Age Distribution; D000368:Aged; D016009:Chi-Square Distribution; D004381:Duodenal Ulcer / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D016896:Treatment Outcome