A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers

Background: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (p = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. (Gastrointest Endosc 2011;73:900-8.)