Nonsurgical Option for Peptic Ulcers

Jim Kling

June 01, 2011

June 1, 2011 — Patients with ulcer bleeding who have failed endoscopic hemostasis gain relief from transarterial embolization (TAE). The procedure leads to fewer surgeries, has fewer associated complications, and does not increase overall mortality, according to a study published in the May issue of Gastrointestinal Endoscopy.

Patients with bleeding peptic ulcers are generally recommended for surgery if endoscopic hemostasis does not work, but surgical procedures carry a high risk for morbidity and mortality, explain lead author Tiffany Cho-Lam Wong, MRCSEd, from the Institute of Digestive Disease, Chinese University Hong Kong, and colleagues.

TAE has been recommended as an alternative, but it has not been well studied. The researchers designed a retrospective study to compare the outcomes of TAE and salvage surgery in patients with peptic ulcers who had failed endoscopic hemostasis. They determined rates of all-cause mortality, rebleeding, reintervention, and complications.

Thirty-two patients were included in the TAE group: 25 patients had bleeding in the gastroduodenal artery, 4 had bleeding in the left gastric artery, 2 had bleeding in the right gastric artery, and 1 had bleeding in the splenic artery. Fifteen patients (46.9%) had active extravasation, 26 patients underwent embolization, and the procedure was successful in 23 patients (88.5%).

There were 11 cases of bleeding recurrence (34.4%) in the TAE group compared with 7 (12.5%) of the 56 patients who underwent surgery (P = .01). There was a higher rate of complications in the surgery group (67.9%) than the TAE group (40.6%; P = .01). Thirty-day mortality rates were not significantly different between the groups (25% for TAE vs 30.4% for surgery; P = .77). Likewise, no difference was seen in mean length of hospital stay (17.3 days for TAE vs 21.6 days for surgery; P = .09) or need for transfusion (15.6 units for TAE vs 14.2 units for surgery; P = .60).

An accompanying editorial welcomed the finding. "There will always be selected patients in whom endoscopic hemostasis therapy fails, who may not be candidates for embolization therapy or in whom it fails, or who may not have access to interventional radiology hemostasis techniques. But the role of the surgeon in this clinical sphere is certainly diminishing and will continue to diminish in ensuing years," the editorialist, Ian M. Gralnek, MD, MSHS, FASGE, from the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, and the Department of Gastroenterology, Rambam Health Care Medical Center, Haifa, Israel, wrote.

The authors and editorialist have disclosed no relevant financial relationships.

Gastrointest Endosc. 2011;5:900-908. Abstract

Gastrointest Endosc. 2011;5:909-910. Full text