Transcatheter Arterial Embolization Compared With Surgery for Uncontrolled Peptic Ulcer Bleeding: A Population-based...

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Oncology

Background:

• Peptic ulcer bleeding (PUB) carries a high mortality rate, particularly for patients requiring surgical intervention.
• Endoscopic interventions may fail to achieve hemostasis in severe cases of PUB.

Purpose of the Study:

• To compare outcomes of transcatheter arterial embolization (TAE) versus conventional surgery for peptic ulcer bleeding refractory to endoscopic treatment.
• To evaluate all-cause mortality, re-bleeding rates, re-intervention needs, hospitalization duration, and complication risks.

Main Methods:

• Population-based cohort study in Stockholm, Sweden (2000-2014).
• Inclusion of 282 patients (97 TAE, 185 surgery) with refractory peptic ulcer bleeding.
• Multivariable Cox-regression analysis adjusted for key demographic and clinical factors.

Main Results:

• Transcatheter arterial embolization (TAE) was associated with a 34% reduction in overall mortality compared to surgery (adjusted HR 0.66).
• TAE group experienced significantly shorter hospital stays (8 vs. 16 days) and fewer complications (8.3% vs. 32.2%).
• The risk of re-bleeding was higher in the TAE group (HR 2.48).

Conclusions:

• Transcatheter arterial embolization (TAE) demonstrates a favorable prognosis compared to surgery for peptic ulcer bleeding unresponsive to endoscopic therapy.
• Reduced hospital stay and lower complication rates associated with TAE outweigh the increased risk of re-bleeding.
• TAE is recommended as a primary treatment option for patients with refractory peptic ulcer bleeding.