title: Transcatheter embolization as the new reference standard for endoscopically unmanageable upper gastrointestinal bleeding.
abstract: Acute nonvariceal upper gastrointestinal bleeding (UGIB) is a major medical emergency problem associated with significant morbidity and mortality. Endoscopy is considered the first method of choice to detect and treat UGIB. Endoscopic therapy usually achieves primary hemostasis, but 10%-30% of these patients have repeat bleeding. In patients in whom hemostasis is not achieved with endoscopic techniques, treatment with transcatheter angiographic embolization (TAE) or surgery is needed. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. A large number of studies support the use of TAE as salvage therapy as an alternative to surgery. However, few studies have compared the results of TAE with that of emergency surgery in terms of efficiency, the frequency of repeat bleeding, and complications. Recently, Ang et al retrospectively compared the outcome of TAE and surgery as salvage therapy of UGIB after failed endoscopic treatment. There were no significant differences in 30 d mortality, complication rates and length of stay although higher rebleeding rates were observed after TAE compared with surgery. In this commentary, we discuss the advantages and drawbacks of these two therapeutic strategies for UGIB. We also attempt to define the exact role of TAE for acute nonvariceal UGIB.
authors: Romaric Loffroy, Louis Estivalet, Violaine Cherblanc, Damien Sottier, Boris Guiu, Jean-Pierre Cercueil, Denis Krausé, Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 21079 Dijon Cedex, France.
authors: Romaric
authors: R
authors: Loffroy
authors: Louis
authors: L
authors: Estivalet
authors: Violaine
authors: V
authors: Cherblanc
authors: Damien
authors: D
authors: Sottier
authors: Boris
authors: B
authors: Guiu
authors: Jean-Pierre
authors: JP
authors: Cercueil
authors: Denis
authors: D
authors: Krausé
keywords: Endoscopic hemostasis; Surgery; Transcatheter embolization; Upper gastrointestinal bleeding