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

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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926 Supplementary Transcatheter Arterial Embolization After Successful Endoscopic Hemostasis Prevents Rebleeding in Peptic Ulcer Bleeding

Gastroenterology ◽

10.1016/s0016-5085(13)60590-9 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-165 ◽

Cited By ~ 1

Author(s):

Stig B. Laursen ◽

Jane M. Hansen ◽

Ove B. Schaffalitzky de Muckadell

Keyword(s):

Peptic Ulcer ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding

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

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00371-2 ◽

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.

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

10.21203/rs.3.rs-111096/v1 ◽

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.

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The results of using endovascular methods for stopping ulcerative gastroduodenal bleeding

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov62306 ◽

2021 ◽

Vol 13 (1) ◽

pp. 103-108

Author(s):

Georgiy I. Sinenchenko ◽

Vladimir G. Verbitskiy ◽

Andrey E. Demko ◽

Aleksey N. Sekeyev ◽

Sergey A. Alentyev ◽

...

Keyword(s):

Blood Loss ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Main Group ◽

Control Group ◽

Recurrent Bleeding ◽

Control Groups ◽

Somatic Condition ◽

Results Of Treatment ◽

And Control

This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 3.7 and 60.7 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

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Endoscopically unmanageable peptic ulcer bleeding: transcatheter arterial embolization remains the first-line therapy in 2020

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01442-w ◽

2020 ◽

Vol 46 (5) ◽

pp. 1037-1038

Author(s):

Olivier Chevallier ◽

Nicolas Falvo ◽

Marco Midulla ◽

Romaric Loffroy

Keyword(s):

Peptic Ulcer ◽

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding ◽

First Line ◽

First Line Therapy ◽

Line Therapy

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Prophylactic Arterial Embolization as the Possible New Gold Standard for High-risk Peptic Ulcer Bleeding After Achieved Endoscopic Hemostasis

Journal of Clinical Gastroenterology ◽

10.1097/mcg.0000000000000282 ◽

2015 ◽

Vol 49 (5) ◽

pp. 448

Author(s):

Romaric Loffroy

Keyword(s):

Peptic Ulcer ◽

High Risk ◽

Gold Standard ◽

Arterial Embolization ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Peptic Ulcer Bleeding

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Transcatheter arterial embolization should be the salvage treatment of choice in all patients with bleeding from duodenal ulcers resistant to endoscopic hemostasis

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521003793733 ◽

2010 ◽

Vol 45 (7-8) ◽

pp. 1003-1004 ◽

Cited By ~ 3

Author(s):

Romaric Loffroy

Keyword(s):

Transcatheter Arterial Embolization ◽

Arterial Embolization ◽

Salvage Treatment ◽

Endoscopic Hemostasis ◽

Duodenal Ulcers

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Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

Endoscopy International Open ◽

10.1055/s-0043-118794 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1159-E1164 ◽

Cited By ~ 11

Author(s):

Oscar Cahyadi ◽

Markus Bauder ◽

Benjamin Meier ◽

Karel Caca ◽

Arthur Schmidt

Keyword(s):

Gastrointestinal Bleeding ◽

Salvage Therapy ◽

Upper Gastrointestinal Bleeding ◽

Clinical Success ◽

Treatment Algorithm ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Recurrent Bleeding ◽

Technical Success ◽

Upper Gastrointestinal

Abstract Background and study aims TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a treatment algorithm for TC-325 use.

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