title: Optimal nonsurgical management of peptic ulcer bleeding, including arterial embolization is associated with a mortality below 1%.
abstract: BACKGROUND
  Management of high-risk peptic ulcer bleeding (PUB) consists in a high-dose infusion of proton pump inhibitors (PPIs) with double endoscopic treatment. If bleeding recurs, a second endoscopic treatment is required. Surgical management should be performed in case of endoscopic treatment failure, or if a second rebleeding occurs. Arterial embolization of PUB has been shown efficient and safe in small retrospective series, but optimal medical treatment was not used.
  
  
  OBJECTIVE
  Prospective assessment of the feasibility and the efficacy of arterial embolization of endoscopically unmanageable PUB, after optimal medical treatment.
  
  
  METHODS
  All consecutive patients referred to our intensive care unit (ICU) for high-risk PUB received high-dose PPIs and underwent double endoscopic treatment when possible. Arterial embolization was proposed in primary failure to endoscopic treatment, in case of failure of the second endoscopic treatment, or if a second recurrence occurred.
  
  
  RESULTS
  One hundred and twenty-eight patients with PUB were enrolled between January 2008 and December 2009. Arterial embolization, performed in 11 patients, was efficient in nine patients. Surgery was performed in two patients (one after inefficient embolization, and one with embolization-related complication). One patient died during hospitalization.
  
  
  CONCLUSIONS
  Arterial embolization seems to be efficient for endoscopically unmanageable PUB. In our series, one patient developed severe complication related to the procedure and died. If arterial embolization could be proposed before surgery in case of refractory PUB, large prospective studies are needed.
authors.affiliation: UPMC, Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Pierre-et-Marie-Curie University, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France. marika_rudler@yahoo.fr
authors.forename: Marika
authors.initials: M
authors.lastname: Rudler
authors.forename: Philippe
authors.initials: P
authors.lastname: Cluzel
authors.forename: Julien
authors.initials: J
authors.lastname: Massard
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Vaillant
authors.forename: Adeline
authors.initials: A
authors.lastname: Martin-Dupray
authors.forename: Séverine
authors.initials: S
authors.lastname: Noullet
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies