Over-the-scope clip versus transcatheter arterial embolization for refractory peptic ulcer bleeding-Apropensity score matched analysis.

Abstract

BackgroundTranscatheter arterial embolization (TAE) or surgery are standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over‐the‐scope clips (OTSC) have shown superiority to standard endoscopic treatment.ObjectiveTo compare OTSC treatment to TAE in refractory peptic ulcer bleeding.Patients and MethodsIn this retrospective, multicenter study, 128 patients treated with OTSC (n = 66) or TAE (n = 62) for refractory PUB between 2009 and 2019 in four academic centers were analyzed. Primary endpoint was clinical success (hemostasis + no rebleeding within 7 days). Secondary endpoints were adverse events, length of ICU stay, and mortality. Propensity score matching was performed to adjust for differences in baseline characteristics.ResultsPatients characteristics were similar in both groups but ulcers in the TAE group were larger, more often located in the duodenal bulb (85.5% vs. 65.2%; p = 0.014), and that the proportion of Forrest Ia bleedings was higher (38.7% vs. 19.7%; p = 0.018). Clinical success was comparable in both groups (74.2% vs. 59.7%; p = 0.092). Stay on the intensive care unit (ICU) was significantly longer in the TAE group (mean 8.0 vs. 4.7 days; p = 0.002). Serious adverse events after re‐therapy (12.9% vs. 1.5%; p = 0.042) and in‐hospital mortality were significantly higher in the TAE group (9.1 vs. 22.6%, OR 2.92 [95% CI 1.04–8.16]; p = 0.05). After propensity score matching, the differences found regarding ICU stay (4.9± 5.9 and 9.2 ± 11.2; p = 0.009) and in‐hospital mortality (5% vs. 22.5%; OR 5.52 [95% CI: 1.11–27.43]; p = 0.048) stayed significant.ConclusionsOTSC treatment for refractory PUB was superior to TAE in terms of ICU stay and in‐hospital mortality.