title: A comparison of surgery versus transcatheter angiographic embolization in the treatment of nonvariceal upper gastrointestinal bleeding uncontrolled by endoscopy.
abstract: BACKGROUND
  Patients with recurrent nonvariceal upper gastrointestinal bleeding who have failed endoscopic therapy pose a challenge. Percutaneous transcatheter angiographic embolization (TAE) is an alternative to surgery but remains controversial. This study compares the treatment outcomes in patients with recurrent nonvariceal upper gastrointestinal bleeding.
  
  
  METHODS
  A retrospective single-centre study of consecutive patients who underwent TAE (January 2007-December 2010) compared with patients treated surgically (January 2004-December 2010) was conducted. Patient demographics, comorbidities, rebleeding rates, length of stay and mortality were compared.
  
  
  RESULTS
  Thirty [23 men; age (SD) 66.5±15.6 years] and 63 [41 men; age (SD) 68.2±15.0 years, NS] patients underwent TAE and surgery after a mean (SD) of 1.7±1.0 and 2.1±1.1 (NS) gastroscopies, respectively, for gastric ulcers (n=28), duodenal ulcers (n=53), small-bowel diverticuli (n=7), jejunal ulcer (n=1) and gastric Dieulafoy's lesions (n=2). Ten (33.3%) and 44 (69.8%) patients who underwent TAE and surgery, respectively, had an American Society of Anesthesiologists status of at least 2 (P=0.001). Higher rebleeding rates were observed after TAE compared with surgery [n=14 (46.7%) vs. 8 (12.7%), P=0.001]; however, there were no significant differences in 30-day mortality (16.7 vs. 19.0%, NS), complication rates (46.7 vs. 60.3%, NS) and length of stay (45.1±9.8 vs. 25.5±18.1 days, P=0.06). Twenty-four out of 30 patients (80%) who underwent TAE achieved haemostasis after a median (SD) of 2.0 (1.2) TAE procedures. Rebleeding occurred in five out of seven patients (71%) who underwent TAE for small-bowel diverticular bleeding.
  
  
  CONCLUSIONS
  TAE averted the need for surgery in high-risk patients. Its role in low surgical risk patients or patients with small-bowel diverticular bleeding requires further study.
authors.affiliation: Department of Gastroenterology, Changi General Hospital, Singapore. ang_daphne@yahoo.com
authors.forename: Daphne
authors.initials: D
authors.lastname: Ang
authors.forename: Eng Kiong
authors.initials: EK
authors.lastname: Teo
authors.forename: Andrew
authors.initials: A
authors.lastname: Tan
authors.forename: Salleh
authors.initials: S
authors.lastname: Ibrahim
authors.forename: Poh Seng
authors.initials: PS
authors.lastname: Tan
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Kwong Ming
authors.initials: KM
authors.lastname: Fock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004240:Diverticulum / Q000601:surgery / Q000628:therapy; D004381:Duodenal Ulcer / Q000601:surgery / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005773:Gastroscopy; D006801:Humans; D007421:Intestine, Small / Q000002:abnormalities / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome