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 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 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.

EFFICACY OF INITIAL AND PERMANENT HEMOSTASIS OF THE ENDOSCOPIC HEMOCLIP METHOD COMBINED WITH HIGH-DOSE INFUSION OF PROTON PUMP INHIBITOR IN PATIENTS WITH PEPTIC ULER BLEEDING

2018 ◽  
pp. 15-21
Author(s):  
Hieu Tam Huynh ◽  
Dang Quy Dung Ho
Keyword(s):  
Peptic Ulcer ◽  
Success Rate ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Injection Sclerotherapy ◽  
High Dose ◽  
Peptic Ulcers ◽  
Peptic Ulcer Bleeding ◽  
Bleeding Peptic Ulcers ◽  
Hemostatic Therapy

Background: Peptic ulcer bleeding is one of the common medical emergencies. The hemostatic efficacy of endoscopic therapeutic modalities has been reported in many studies and frequently has been found to exceed 90%. Four groups of modalities are used in the endoscopic management of bleeding peptic ulcers: thermal probe methods, injection sclerotherapy, local spray methods, and mechanical hemostatic therapy. The endoscopic hemoclip method is a safe and effective hemostatic therapy for managing bleeding peptic ulcers. Objective: To determine the success rate of hemoclip in endoscopic hemostasis. Patients and methods: Clinical intervention study on 36 patients with peptic ulcer bleeding admitted in Can Tho Central General Hospital from May 2012 to November 2014. All the patients underwent emergency endoscopy for hemostasis by hemoclip and high-dose PPI use. Results: The success rate of initial hemostasis was 97.2%, and permanent hemostasis was 91.7%. The rates of rebleeding, surgery, mortality were 11.1%, 5.6%, 2.8%, respectively. Conclusion: Endoscopic hemostasis therapy by clipping combined with high- dose PPI is an effective, relatively safe treatment for peptic ulcer bleeding. Key words: Peptic ulcer bleeding, hemoclip, endoscopic hemostasis therapy

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