title: Prophylactic Transcatheter Arterial Embolization After Successful Endoscopic Hemostasis in the Management of Bleeding Duodenal Ulcer.
abstract: OBJECTIVE
  The aim of this study was to demonstrate the new strategy of prophylactic transcatheter arterial embolization (TAE) of the gastroduodenal artery after endoscopic hemostasis of bleeding duodenal ulcers.
  
  
  BACKGROUND
  TAE is a well-established method for the treatment of recurrent or refractory ulcer bleeding resistant to endoscopic intervention, which increasingly replaces surgical procedures. A new approach for improving outcome and reducing rebleeding episodes is the supplemental and prophylactic TAE after successful endoscopic hemostasis.
  
  
  METHODS
  This retrospective study included all patients (n=117) treated from 2008 to 2012 for duodenal ulcer bleeding. After initial endoscopic hemostasis, patients were assessed regarding their individual rebleeding risk. Patients with a low rebleeding risk (n=47) were conservatively treated, patients with a high risk for rebleeding (n=55) had prophylactic TAE of the gastroduodenal artery, and patients with endoscopically refractory ulcer bleeding received immediate TAE.
  
  
  RESULTS
  The technical success of prophylactic TAE was 98% and the clinical success was 87% of cases. Rebleeding occurred in 11% of patients with prophylactic TAE and was successfully treated with repeated TAE or endoscopy. The major complication rate was 4%. Surgery was necessary in only 1 prophylactic TAE patient (0.9%) during the whole study period. Mortality associated with ulcer bleeding was 4% in patients with prophylactic TAE.
  
  
  CONCLUSIONS
  Prophylactic TAE in patients with duodenal ulcers at high risk for rebleeding was feasible, effective at preventing the need for surgery, and had low major complication rates. Given these promising outcomes, prophylactic TAE should be further evaluated as a preventative therapy in high-risk patients.
authors.affiliation: Departments of *General and Visceral Surgery †Diagnostic and Interventional Radiology and Neuroradiology ‡2nd Department of Internal Medicine, HELIOS Hospital Erfurt, Erfurt, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Mille
authors.forename: Juliane
authors.initials: J
authors.lastname: Huber
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Wlasak
authors.forename: Thomas
authors.initials: T
authors.lastname: Engelhardt
authors.forename: Yvette
authors.initials: Y
authors.lastname: Hillner
authors.forename: Henri
authors.initials: H
authors.lastname: Kriechling
authors.forename: Rene
authors.initials: R
authors.lastname: Aschenbach
authors.forename: Katrin
authors.initials: K
authors.lastname: Ende
authors.forename: Jens-Gerd
authors.initials: JG
authors.lastname: Scharf
authors.forename: Ralf
authors.initials: R
authors.lastname: Puls
authors.forename: Albrecht
authors.initials: A
authors.lastname: Stier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004381:Duodenal Ulcer / Q000473:pathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome