A comparison of surgery versus transcatheter angiographic embolization in the treatment of nonvariceal upper gastrointestinal bleeding uncontrolled by endoscopy

作者：Ang Daphne^*; Teo Eng Kiong; Tan Andrew; Ibrahim Salleh; Tan Poh Seng; Ang Tiing Leong; Fock Kwong Ming

来源：European Journal of Gastroenterology and Hepatology, 2012, 24(8): 929-938.

DOI：10.1097/MEG.0b013e32835463bc

• angiography
• embolization
• gastrointestinal haemorrhage

Background Patients with recurrent nonvariceal upper gastrointestinal bleeding who have failed endoscopic therapy pose a challenge. Percutaneous transcatheter angiographic embolization (TAE) is an alternative to surgery but remains controversial. This study compares the treatment outcomes in patients with recurrent nonvariceal upper gastrointestinal bleeding.
Methods A retrospective single-centre study of consecutive patients who underwent TAE (January 2007-December 2010) compared with patients treated surgically (January 2004-December 2010) was conducted. Patient demographics, comorbidities, rebleeding rates, length of stay and mortality were compared.
Results Thirty [23 men; age (SD) 66.5 +/- 15.6 years] and 63 [41 men; age (SD) 68.2 +/- 15.0 years, NS] patients underwent TAE and surgery after a mean (SD) of 1.7 +/- 1.0 and 2.1 +/- 1.1 (NS) gastroscopies, respectively, for gastric ulcers (n=28), duodenal ulcers (n=53), small-bowel diverticuli (n=7), jejunal ulcer (n=1) and gastric Dieulafoy's lesions (n=2). Ten (33.3%) and 44 (69.8%) patients who underwent TAE and surgery, respectively, had an American Society of Anesthesiologists status of at least 2 (P=0.001). Higher rebleeding rates were observed after TAE compared with surgery [n=14 (46.7%) vs. 8 (12.7%), P=0.001]; however, there were no significant differences in 30-day mortality (16.7 vs. 19.0%, NS), complication rates (46.7 vs. 60.3%, NS) and length of stay (45.1 +/- 9.8 vs. 25.5 +/- 18.1 days, P=0.06). Twenty-four out of 30 patients (80%) who underwent TAE achieved haemostasis after a median (SD) of 2.0 (1.2) TAE procedures. Rebleeding occurred in five out of seven patients (71%) who underwent TAE for small-bowel diverticular bleeding.
Conclusion TAE averted the need for surgery in high-risk patients. Its role in low surgical risk patients or patients with small-bowel diverticular bleeding requires further study.

• 出版日期2012-8