NDLI: A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Wong, Tiffany C. L. Wong, Ka-Tak Chiu, Philip W. Y. Teoh, Anthony Y. B. Yu, Simon C. H. Au, Kim W. L. Lau, James Y. W.
Spatial Coverage	Hong Kong
Description	Country affiliation: China Author Affiliation: Wong TC ( Department of Surgery, The Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.)
Abstract	BACKGROUND: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. OBJECTIVE: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. DESIGN: Retrospective study. SETTING: A university hospital. PATIENTS: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. INTERVENTIONS: TAE and surgery as salvage of peptic ulcer bleeding. MAIN OUTCOMES MEASUREMENTS: All-cause mortality, rebleeding, reintervention, and complication rate. RESULTS: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P=.01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P=.01). There was no difference in 30-day mortality (25% vs 30.4%, P=.77), mean length of hospital stay (17.3 vs 21.6 days, P=.09), and need for transfusion (15.6 vs 14.2 units, P=.60) between the TAE and surgery groups. LIMITATIONS: Retrospective study. CONCLUSIONS: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications.
File Format	HTM / HTML
ISSN	00165107
Issue Number	5
Volume Number	73
e-ISSN	10976779
Journal	Gastrointestinal Endoscopy
Language	English
Publisher	Elsevier
Publisher Date	2011-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Gastroenterology Angiography Methods Celiac Artery Duodenal Ulcer Therapy Embolization, Therapeutic Hemostasis, Endoscopic Peptic Ulcer Hemorrhage Aged Cause Of Death Trends Duodenum Blood Supply Female Hong Kong Epidemiology Humans Length Of Stay Male Mortality Recurrence Retrospective Studies Stomach Survival Rate Treatment Failure Treatment Outcome Comparative Study Journal Article
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Gastroenterology

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