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Transcatheter Arterial Embolization Effective For Recurrent Upper Gastrointestinal Bleeding

February 1, 2010
Written by: , Filed in: Gastrointestinal Imaging
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The frequency of upper gastrointestinal (UGI) bleeding has decreased with the decreasing prevalence of peptic ulcer disease.

In the elderly, the incidence of upper gastrointestinal bleeding remains high, however, probably because of widespread use of NSAIDs and aspirin.

Overall, 70% to 80% of UGI bleeding stops voluntarily, and the remainder is treated endoscopically.

If the patient rebleeds, which occurs 10% to 30% of the time, or if endoscopic therapy fails, then rebleeds are treated by surgery or transcatheter arterial embolization (TAE).

There has only been one study that clearly shows better outcome in the elderly population using TAE versus surgery.

The study was conducted to compare outcomes of TAE and surgery as salvage therapy of UGI bleeding after failed endoscopic treatment.

Study Design/Participants
Retrospective review of records of 658 patients who presented with UGI bleeding in the authors’ institution over 8 years were studied.

Methodology
86% of these patients either were treated successfully endoscopically or stopped bleeding spontaneously. In the remaining 91 patients, 40 had TAE, and 51 had surgery.

Results
TAE patients were older compared to those in the surgical group. Hospitalization was slightly longer in the surgical group.

In the TAE group, primary hemostasis after 1 treatment occurred in 75%. In the remaining 25%, half were treated successfully with a second TAE, and the remaining 4 of 5 treated successfully with surgery.

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In 82% of surgical patients, primary hemostasis was achieved with 1 surgery.

In 8 of 9 remaining patients, bleeding was successfully treated with TAE, and the last patient was treated successfully with repeat surgery.

Morbidity of the surgical group included 2 additional patients for reoperation.

Thirty-day mortality was lower in the TAE group (3%) versus the surgical group (14%).

Of note, there was a 50% 5-year survival of all patients after the episode of bleeding, which was significantly lower than in age-matched controls.

Conclusions/Reviewer’s Comments
Patients in the TAE group had a significantly lower 30-day mortality rate despite the fact that they were older and had more comorbidities than their surgically treated counterparts.

Patients who had surgery had higher morbidity secondary to surgery compared to TAE patients.

Repeat bleeding after TAE was slightly higher than in the surgical group, but a second TAE procedure usually stopped it completely.

TAE was also successful in stopping UGI bleeding after surgical therapy failed.

Another positive outcome was that TAE avoided second surgery in general in these more elderly patients.

Limitations of the study include a small number of patients, and the retrospective nature of the study.

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