Abstract
Background: Before the advent of transcatheter arterial embolization (TAE), emergency surgery was the only choice for patients with peptic ulcer bleeding refractory to endoscopic therapy. This study compared the effectiveness of TAE and surgery in patients with peptic ulcer bleeding refractory to endoscopic hemostasis. Materials and Methods: This was a retrospective analysis of 116 patients with peptic ulcer bleeding refractory to endoscopic treatment at our institution. Eighty-three cases were treated with surgery, and 33 cases were managed with TAE. Clinical outcomes were evaluated. Results: There were no differences between groups with respect to the mortality rate (p > 0.05), length of hospital stay, or medical diseases related to mortality. The TAE group exhibited a significantly higher rebleeding rate (p < 0.05). Rebleeding predominantly occurred in patients with type Ia peptic ulcers (Forrest classification) irrespective of the treatment approach. The rebleeding rates in such patents were 30.2% and 56.3% in the surgery and TAE groups, respectively. Patients with rebleeding after further therapy showed high mortality rates (68.6%). The rebleeding rate was not significantly different between the subgroups of patients with type Ia lesions, although there was a higher mortality rate in the TAE group (27.9% vs. 75%, p = 0.001). Conclusions: TAE may be the first-choice therapy for patients with peptic ulcer bleeding refractory to endoscopic treatment, whereas emergency surgery may be used as an alternative in patients with type Ia bleeding at institutions with no 24-hour radiology service or when no experienced radiologist is available.
Highlights
Despite the improvements in perioperative management and endoscopy techniques, peptic ulcer bleeding (PUB)How to cite this paper: Lee, T.Y. and Tung, C.C. (2016) Management of Peptic Ulcer Bleeding Refractory to Endoscopic Treatment
There were no other differences between the surgery and transcatheter arterial embolization (TAE) groups (Table 1)
There were no significant differences between groups with respect to mortality rates, length of hospital stay, or mortality related to medical diseases, the mortality rate tended to be higher in the TAE group (51.5% vs. 38.6%, p = 0.202) (Table 3)
Summary
Despite the improvements in perioperative management and endoscopy techniques, peptic ulcer bleeding (PUB)How to cite this paper: Lee, T.Y. and Tung, C.C. (2016) Management of Peptic Ulcer Bleeding Refractory to Endoscopic Treatment. (2016) Management of Peptic Ulcer Bleeding Refractory to Endoscopic Treatment. Before the advent of transcatheter arterial embolization (TAE), emergency surgery was the only choice for patients with peptic ulcer bleeding refractory to endoscopic therapy. This study compared the effectiveness of TAE and surgery in patients with peptic ulcer bleeding refractory to endoscopic hemostasis. The rebleeding rate was not significantly different between the subgroups of patients with type Ia lesions, there was a higher mortality rate in the TAE group (27.9% vs 75%, p = 0.001). Conclusions: TAE may be the first-choice therapy for patients with peptic ulcer bleeding refractory to endoscopic treatment, whereas emergency surgery may be used as an alternative in patients with type Ia bleeding at institutions with no 24-hour radiology service or when no experienced radiologist is available
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have