scholarly journals Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qian Yu ◽  
Chenyu Liu ◽  
Biagio Collura ◽  
Rakesh Navuluri ◽  
Mikin Patel ◽  
...  
Keyword(s):  
High Risk ◽  
Transcatheter Arterial Embolization ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Arterial Embolization ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Cochrane Library ◽  
Peptic Ulcers ◽  
Rebleeding Rate

Abstract Background To conduct a meta-analysis to assess the safety and efficacy of prophylactic transcatheter arterial embolization (PTAE) for the treatment of high-risk bleeding peptic ulcers after achieving endoscopic hemostasis. Methods PubMed and Cochrane Library were queried for full-text articles published up to December 2019. The following keywords were used: “prophylactic embolization”, “supplement embolization”, “gastrointestinal bleeding”, and “ulcer bleeding”. High-risk ulcers were defined based on endoscopic findings (i.e., large ulcers, Forrest class I-IIb) and/or clinical presentation (i.e., hypotension, decreased hemoglobin during endoscopy). Only comparative studies investigating PTAE versus conservative treatment after achieving endoscopic hemostasis were included. Baseline study characteristics, rebleeding rate, need for surgery, mortality, and PTAE-related complication rates were investigated. Quantitative analyses were performed with Stata 15.1. Results Among the five included original studies, a total of 265 patients received PTAE and 617 were managed conservatively after endoscopy. The rebleeding rate (6.8% vs 14.3%, p = 0.003) and mortality (4.5% vs 8.8%, p = 0.032) of patients from the PTAE group were lower than the control group. PTAE also reduced the cumulative need for future surgical intervention (3.0% vs 14.4%, p = 0.005). The PTAE-related major and minor events were 0.75% and 14.4%, respectively. Conclusion PTAE had therapeutic potentials in reducing rebleeding risk, need for surgical intervention, and morality in high-risk peptic ulcers after achieving endoscopic hemostasis. The embolization-associated adverse events were minimal. Future studies should aim to increase the sample size and resources for performing endovascular interventions.

scholarly journals Prophylactic transcatheter arterial embolization for high-risk ulcers following endoscopic hemostasis: A meta-analysis

2020 ◽  
Author(s):  
Qian Yu ◽  
Chenyu Liu ◽  
Mikin Patel ◽  
Osman Ahmed
Keyword(s):  
High Risk ◽  
Transcatheter Arterial Embolization ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Arterial Embolization ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Cochrane Library ◽  
Complication Rates ◽  
Peptic Ulcers

Abstract Background: To conduct a meta-analysis to assess the safety and efficacy of prophylactic transcatheter arterial embolization (PTAE) for the treatment of high-risk bleeding peptic ulcers after achieving endoscopic hemostasis.Methods: PubMed and Cochrane Library were queried for full-text articles published up to December 2019. The following keywords were used: “prophylactic embolization”, “supplement embolization”, “gastrointestinal bleeding”, and “ulcer bleeding”. High-risk ulcers were defined based on endoscopic findings (i.e. large ulcers, Forrest class I-IIb) and/or clinical presentation (i.e. hypotension, decreased hemoglobin during endoscopy). Only comparative studies investigating PTAE versus conservative treatment after achieving endoscopic hemostasis were included. Baseline study characteristics, re-bleeding rate, need for surgery, mortality, and PTAE-related complication rates were investigated. Quantitative analyses were performed with STATA 15.1.Results: Among the five original studies included, a total of 265 patients received PTAE and 617 were managed conservatively after endoscopy. The rebleeding rate (6.8% vs 14.3%, p=0.003) and mortality (4.5% vs 8.8%, p=0.032) of patients from the PTAE group were lower than the control group. PTAE also reduced the cumulative need of future surgical intervention (3.0% vs 14.4%, p=0.005). The PTAE-related major and minor events were 0.75% and 14.4%, respectively. Conclusion: PTAE had therapeutic potentials in reducing rebleeding risk, need of surgical intervention, and morality in high-risk peptic ulcers after achieving endoscopic hemostasis. The embolization-associated adverse events were minimal. Future studies should aim to increase the sample size and resources for performing endovascular interventions.

scholarly journals Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Aleksejs Kaminskis ◽  
Patricija Ivanova ◽  
Aina Kratovska ◽  
Sanita Ponomarjova ◽  
Margarita Ptašņuka ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Mortality Rate ◽  
Surgical Intervention ◽  
Transarterial Embolization ◽  
Bleeding Peptic Ulcer ◽  
Endoscopic Hemostasis ◽  
Control Group ◽  
Safe Procedure ◽  
Rebleeding Rate

Abstract Background Upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding. Methods During the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups—P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed. Results From 738 patients with a bleeding peptic ulcer, 399 were at high risk for rebleeding after endoscopic hemostasis. From this cohort, 58 patients underwent P-TAE, and 341 were allocated to the EA. A significantly lower rebleeding rate was observed in the P-TAE group, 3.4% vs. 16.2% in the EA group; p = 0.005. The need for surgical intervention reached 10.3% vs. 20.6% in the P-TAE and EA groups accordingly; p = 0.065. Patients that underwent P-TAE required less FFP, 1.3 unit vs. 2.6 units in EA; p = 0.0001. The mortality rate was similar in groups with a tendency to decrease in the P-TAE group, 5.7% vs. 8.5% in EA; p = 0.417. Conclusion P-TAE is a feasible and safe procedure, and it may reduce the rebleeding rate and the need for surgical intervention in patients with a bleeding peptic ulcer when the rebleeding risk remains high after primary endoscopic hemostasis.

scholarly journals Bleeding Duodenal Ulcer: Strategies in High-Risk Ulcers

2020 ◽  
pp. 1-11
Author(s):  
Markus Mille ◽  
Thomas Engelhardt ◽  
Albrecht Stier
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Transcatheter Arterial Embolization ◽  
Multidisciplinary Treatment ◽  
Arterial Embolization ◽  
Gastric Ulcers ◽  
Future Perspective ◽  
Ulcer Bleeding ◽  
Pharmacologic Therapy ◽  
Duodenal Ulcers

<b><i>Background:</i></b> Acute peptic ulcer bleeding is still a major reason for hospital admission. Especially the management of bleeding duodenal ulcers needs a structured therapeutic approach due to the higher morbidity and mortality compared to gastric ulcers. Patient with these bleeding ulcers are often in a high-risk situation, which requires multidisciplinary treatment. <b><i>Summary:</i></b> This review provides a structured approach to modern management of bleeding duodenal ulcers and elucidates therapeutic practice in high-risk situations. Initial management including pharmacologic therapy, risk stratification, endoscopy, surgery, and transcatheter arterial embolization are reviewed and their role in the management of bleeding duodenal ulcers is critically discussed. Additionally, a future perspective regarding prophylactic therapeutic approaches is outlined. <b><i>Key Messages:</i></b> Beside pharmacotherapeutic and endoscopic advances, bleeding management of high-risk duodenal ulcers is still a challenge. When bleeding persists or rebleeding occurs and the gold standard endoscopy fails, surgical and radiological procedures are indicated to manage ulcer bleeding. Surgical procedures are performed to control hemorrhage, but they are still associated with a higher morbidity and a longer hospital stay. In the meantime, transcatheter arterial embolization is recommended as an alternative to surgery and more often replaces surgery in the management of failed endoscopic hemostasis. Future studies are needed to improve risk stratification and therefore enable a better selection of high-risk ulcers and optimal treatment. Additionally, the promising approach of prophylactic embolization in high-risk duodenal ulcers has to be further investigated to reduce rebleeding and improve outcomes in these patients.

Prophylactic arterial embolization in high-risk peptic ulcer bleeding after endoscopic hemostasis is achieved: a new step – authors' reply

2014 ◽  
Vol 49 (6) ◽  
pp. 774-774
Author(s):  
Stig Borbjerg Laursen ◽  
Jane Møller Hansen ◽  
Poul Erik Andersen ◽  
Ove B. Schaffalitzky de Muckadell
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Arterial Embolization ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding

scholarly journals Surgical tactics treatment of the peptic ulcer of the stomach, complicated by bleeding

2018 ◽  
Vol 20 (4) ◽  
pp. 56-60
Author(s):  
G I Sinenchenko ◽  
V G Verbitskii ◽  
A E Demko ◽  
A O Parfenov ◽  
A N Sekeev ◽  
...  
Keyword(s):  
Gastric Ulcer ◽  
Transcatheter Arterial Embolization ◽  
Arterial Embolization ◽  
Palliative Surgery ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Recurrent Bleeding ◽  
Technical Equipment ◽  
Angiographic Embolization ◽  
Somatic Condition

Currently, endoscopic hemostasis is the «gold» standard in the treatment of patients suffering from ulcerative gastroduodenal bleeding. General mortality in ulcerative gastroduodenal bleeding according to the Department of ambulance organization of the research Institute of emergency care. I.I. Dzhanelidze in St. Petersburg in 2016 was 5%, and postoperative8,5%. Transcatheter arterial embolization, due to the development of endovascular hemostasis techniques, is an alternative to palliative surgery in the failure of conservative treatment of ulcerative gastroduodenal bleeding using endoscopic hemostasis techniques, especially in the group of patients with high risk of surgery and adverse outcome. It was found that the reduction in mortality in patients with gastric ulcer bleeding can be achieved by reducing the number of palliative interventions, wider use of angiographic embolization for the prevention and treatment of recurrent bleeding and expanding indications for urgent radical operations outside the recurrence of hemorrhage. The use of transcatheter arterial embolization in elderly patients with severe somatic pathology and recurrent gastric ulcer bleeding can prevent the recurrence of bleeding and perform hemostasis. The success of the transcatheter arterial embolization procedure depends on many factors. Primarily from the anatomical features of the patient. In one case, the patient had a 60% stenosis of the proximal segment of the gastrointestinal splenic trunk, which did not allow the procedure to be performed. Important is the choice of agents for embolization depending on the location and diameter of the source of bleeding. Success also depends on the technical equipment of the hospital and the experience of the surgeon. The absence of significant differences in mortality between the main and control groups, in our opinion, is due to the severity of the General somatic condition of patients included in the study. The obtained results determine the need for further studies to optimize the indications and methods of transcatheter arterial embolization in emergency surgery of gastroduodenal bleeding.

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