Retrospective analysis of surgery and trans-arterial embolization for major non-variceal upper gastrointestinal bleeding.
BACKGROUND
With proton pump inhibitors and current sophisticated endoscopic techniques, the number of patients requiring surgical intervention for upper gastrointestinal bleeding has decreased considerably while trans-arterial embolization is being used more often. There are few direct comparisons between the effectiveness of surgery and embolization.


METHODS
A retrospective study of patients from two Australian teaching hospitals who had surgery or trans-arterial embolization (n = 103) for severe upper gastrointestinal haemorrhage between 2004 and 2012 was carried out. Patient demographics, co-morbidities, disease pathology, length of stay, complications, and overall clinical outcome and mortality were compared.


RESULTS
There were 65 men and 38 women. The median age was 70 (range 36-95) years. Patients requiring emergency surgical intervention (n = 79) or trans-arterial embolization (n = 24) were compared. The rate of re-bleeding after embolization (42%) was significantly higher compared with the surgery group (19%) (P = 0.02). The requirement for further intervention (either surgery or embolization) was also higher in the embolization group (33%) compared with the surgery group (13%) (P = 0.03). There was no statistical difference in mortality between the embolization group (5/24, 20.8%) and the surgical group (13/79, 16.5%) (P = 0.75).


CONCLUSIONS
Emergency surgery and embolization are required in 2.6% of patients with upper gastrointestinal bleeding. Both techniques have high mortalities reflecting the age, co-morbidities and severity of bleeding in this patient group.
Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Ewen A
EA
Griffiths
Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Chris R
CR
McDonald
Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Robert V
RV
Bryant
Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Peter G
PG
Devitt
Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Tim
T
Bright
Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Richard H
RH
Holloway
Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Sarah K
SK
Thompson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
endoscopy; peptic ulcer disease; trans-arterial embolization; upper gastrointestinal bleeding