Bleeding gastric and duodenal ulcers: case-control study comparing angioembolization and surgery

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Gastroenterology

Background:

• Bleeding gastric and duodenal ulcers (BGDUs) pose significant clinical challenges, often requiring advanced interventions when endoscopic hemostasis fails.
• Treatment decisions between transcatheter arterial embolization (TAE) and surgery are critical for patient outcomes.

Purpose of the Study:

• To compare the safety, efficacy, and feasibility of TAE versus surgery for BGDUs refractory to endoscopic hemostasis.
• To evaluate key outcomes including mortality, rebleeding, and complication rates.

Main Methods:

• Retrospective analysis of patients undergoing TAE or surgery for BGDUs after failed endoscopic hemostasis at Helsinki University Hospital (2000-2015).
• Primary outcomes: 30-day mortality and rebleeding rates.
• Secondary outcomes: Postoperative complications, transfusion requirements, and length of intensive care and hospital stays.

Main Results:

• Of 85 patients requiring intervention, 43 had surgery and 42 had TAE. The comparison focused on 24 TAE and 43 surgery patients with active or recurrent bleeding.
• Mortality rates were 12.5% for TAE and 25.6% for surgery (p=0.347); rebleeding rates were 25% for TAE and 16.3% for surgery (p=0.641).
• Transcatheter arterial embolization was associated with significantly fewer postprocedural complications (37.5% vs. 67.4%, p=0.018).

Conclusions:

• Transcatheter arterial embolization and surgery demonstrate comparable 30-day mortality and rebleeding rates for BGDUs after endoscopic failure.
• Given the lower incidence of postoperative complications, TAE is recommended as the preferred hemostatic method when endoscopic interventions are unsuccessful.