title: A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers.
abstract: BACKGROUND
  In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative.
  
  
  OBJECTIVE
  To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed.
  
  
  METHODS
  TAE and surgery as salvage of peptic ulcer bleeding.
  
  
  METHODS
  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 gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P=.01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P=.01). There was no difference in 30-day mortality (25% vs 30.4%, P=.77), mean length of hospital stay (17.3 vs 21.6 days, P=.09), and need for transfusion (15.6 vs 14.2 units, P=.60) between the TAE and surgery groups.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications.
authors.affiliation: Department of Surgery, The Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Tiffany C L
authors.initials: TC
authors.lastname: Wong
authors.forename: Ka-Tak
authors.initials: KT
authors.lastname: Wong
authors.forename: Philip W Y
authors.initials: PW
authors.lastname: Chiu
authors.forename: Anthony Y B
authors.initials: AY
authors.lastname: Teoh
authors.forename: Simon C H
authors.initials: SC
authors.lastname: Yu
authors.forename: Kim W L
authors.initials: KW
authors.lastname: Au
authors.forename: James Y W
authors.initials: JY
authors.lastname: Lau
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D004381:Duodenal Ulcer / Q000628:therapy*; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D016558:Hemostasis, Endoscopic; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D016896:Treatment Outcome