title: The efficacy of transcatheter arterial embolization as the first-choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors.
abstract: OBJECTIVE
  The aim of this retrospective study was to evaluate the efficacy of transcatheter arterial embolization (TAE) as the first-choice treatment in patients with bleeding peptic ulcer after the failure of endoscopic hemostasis. An additional objective was to clarify endoscopic treatment resistance factors.
  
  
  METHODS
  Between April 2004 and December 2010, 554 patients were admitted to Kasugai Municipal Hospital for necessary endoscopic hemostasis for bleeding gastric ulcer or duodenal ulcer. In the patients for whom endoscopic hemostasis failed, TAE was attempted. If TAE failed, the patients underwent surgery. The backgrounds of the patients in whom endoscopic treatment was successful and in whom it failed were compared.
  
  
  RESULTS
  TAE was attempted in 15 patients (2.7%). In 12 (80.0%) of 15 patients, embolization with coils was successful. In one patient (6.7%), embolization was ineffective. This patient underwent emergent salvage surgery. In two (13.3%) of 15 patients, no extravasation was observed during arteriography. These patients were cured with medication. In two patients, ulcer perforation was observed during endoscopy after rebleeding. These patients underwent surgery. In total, 3 (0.5%) of 554 patients underwent surgery. No recurrent bleeding was observed after TAE. Hemoglobin level <8 g/dL at presentation (P = 0.02), Rockall score ≥7 at presentation (P = 0.002), and Forrest class Ia/Ib at initial endoscopic hemostasis (P < 0.001) were found to be independent significant endoscopic treatment resistance factors.
  
  
  CONCLUSIONS
  TAE is a safe and effective first-choice treatment for patients in whom endoscopic hemostasis has failed.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan. ta-katano@nifty.com
authors.forename: Takahito
authors.initials: T
authors.lastname: Katano
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Mizoshita
authors.forename: Kyoji
authors.initials: K
authors.lastname: Senoo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sobue
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takada
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Hisato
authors.initials: H
authors.lastname: Mochiduki
authors.forename: Takanori
authors.initials: T
authors.lastname: Ozeki
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kato
authors.forename: Kayoko
authors.initials: K
authors.lastname: Matsunami
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Ito
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000379:methods*; D004381:Duodenal Ulcer; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies; D013276:Stomach Ulcer; D017211:Treatment Failure; D016896:Treatment Outcome