title: Transcatheter arterial embolization is the first-line therapy of choice in peptic ulcer bleeding not responding to endoscopic therapy.
abstract: OBJECTIVE
  In 5-10% of patients with peptic ulcer bleeding (PUB) it is impossible to achieve endoscopic hemostasis because of severe bleeding. These patients have traditionally been treated surgically. Transcatheter arterial embolization (TAE) may, however, be associated with a better outcome because of the less-invasive nature of the procedure. The aim of the present study was to identify the treatment of choice in endoscopy-refractory PUB.
  
  
  METHODS
  A retrospective study. Consecutive patients treated with surgery or TAE for endoscopy-refractory PUB during a period of 16 years at a university hospital were included. Primary hemostasis, rebleeding rate, mortality, and complications were assessed. Mortality was compared between groups after adjustment for age, comorbidity, and anemia using logistic regression analyses. Comorbidity was quantified using the Charlson comorbidity index (CCI).
  
  
  RESULTS
  One hundred and eighteen patients were included. Patients treated with TAE had a higher CCI (mean: 2.33 vs 1.42; p = .003), and more severe anemia (mean: 6.8 vs 7.9 g/dl; p = .007) compared with patients treated with surgery. Surgery was associated with a higher rate of primary hemostasis (100% vs 91%; p = .007), lower rate of rebleeding (15% vs 40%; p = .004) but also higher rate of complications (60% vs 38%; p = .02) than TAE. Surgery was associated with an increased mortality (Odds ratio: 3.05; p = .033) when adjusting for confounding factors and excluding patients (n = 3) who were not candidates for both interventions.
  
  
  CONCLUSIONS
  We propose use of TAE as first-line therapy in these patients as it may be associated with lower mortality and lower rate of complications compared with surgery.
authors.affiliation: Department of Medical Gastroenterology, Odense University Hospital , Søndre Boulevard 29, Odense C , Denmark.
authors.forename: Stig Borbjerg
authors.initials: SB
authors.lastname: Laursen
authors.forename: Mark
authors.initials: M
authors.lastname: Jakobsen
authors.forename: Michael Milek
authors.initials: MM
authors.lastname: Nielsen
authors.forename: Claus
authors.initials: C
authors.lastname: Hovendal
authors.forename: Ove B
authors.initials: OB
authors.lastname: Schaffalitzky de Muckadell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D004621:Embolization, Therapeutic; D004724:Endoscopy; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: gastrointestinal bleeding; surgery; transcatheter arterial embolization