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Article: A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers

TitleA comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers
Authors
Issue Date2011
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/gie
Citation
Gastrointestinal Endoscopy, 2011, v. 73 n. 5, p. 900-908 How to Cite?
AbstractBackground: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. © 2011 American Society for Gastrointestinal Endoscopy.
Persistent Identifierhttp://hdl.handle.net/10722/169753
ISSN
2015 Impact Factor: 6.217
2015 SCImago Journal Rankings: 2.390
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, TCLen_US
dc.contributor.authorWong, KTen_US
dc.contributor.authorChiu, PWYen_US
dc.contributor.authorTeoh, AYBen_US
dc.contributor.authorYu, SCHen_US
dc.contributor.authorAu, KWLen_US
dc.contributor.authorLau, JYWen_US
dc.date.accessioned2012-10-25T04:54:51Z-
dc.date.available2012-10-25T04:54:51Z-
dc.date.issued2011en_US
dc.identifier.citationGastrointestinal Endoscopy, 2011, v. 73 n. 5, p. 900-908en_US
dc.identifier.issn0016-5107en_US
dc.identifier.urihttp://hdl.handle.net/10722/169753-
dc.description.abstractBackground: In patients with bleeding peptic ulcers in whom endoscopic hemostasis fails, surgery usually follows. Transarterial embolization (TAE) has been proposed as an alternative. Objective: To compare the outcomes of TAE and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed. Design: Retrospective study. Setting: A university hospital. Patients: Patients with peptic ulcer bleeding in whom endoscopic hemostasis failed. Interventions: TAE and surgery as salvage of peptic ulcer bleeding. Main Outcomes Measurements: All-cause mortality, rebleeding, reintervention, and complication rate. Results: Thirty-two patients underwent TAE and 56 underwent surgery. In those who underwent TAE, the bleeding vessels were gastroduodenal artery (25 patients), left gastric artery (4 patients), right gastric artery (2 patients), and splenic artery (1 patient). Active extravasation was seen in 15 patients (46.9%). Embolization was attempted in 26 patients, and angiographic coiling was successful in 23 patients (88.5%). Bleeding recurred in 11 patients (34.4%) in the TAE group and in 7 patients (12.5%) in the surgery group (P = .01). More complications were observed in patients who underwent surgery (40.6% vs 67.9%, P = .01). There was no difference in 30-day mortality (25% vs 30.4%, P = .77), mean length of hospital stay (17.3 vs 21.6 days, P = .09), and need for transfusion (15.6 vs 14.2 units, P = .60) between the TAE and surgery groups. Limitations: Retrospective study. Conclusions: In patients with ulcer bleeding after failed endoscopic hemostasis, TAE reduces the need for surgery without increasing the overall mortality and is associated with fewer complications. © 2011 American Society for Gastrointestinal Endoscopy.en_US
dc.languageengen_US
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/gieen_US
dc.relation.ispartofGastrointestinal Endoscopyen_US
dc.subject.meshAgeden_US
dc.subject.meshAngiography - Methodsen_US
dc.subject.meshCause Of Death - Trendsen_US
dc.subject.meshCeliac Artery - Radiographyen_US
dc.subject.meshDuodenal Ulcer - Therapyen_US
dc.subject.meshDuodenum - Blood Supplyen_US
dc.subject.meshEmbolization, Therapeutic - Methodsen_US
dc.subject.meshFemaleen_US
dc.subject.meshHemostasis, Endoscopicen_US
dc.subject.meshHong Kong - Epidemiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshLength Of Stayen_US
dc.subject.meshMaleen_US
dc.subject.meshPeptic Ulcer Hemorrhage - Mortality - Radiography - Therapyen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshStomach - Blood Supplyen_US
dc.subject.meshSurvival Rate - Trendsen_US
dc.subject.meshTreatment Failureen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleA comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcersen_US
dc.typeArticleen_US
dc.identifier.emailWong, TCL: wongtcl@hku.hken_US
dc.identifier.authorityWong, TCL=rp01679en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/j.gie.2010.11.024en_US
dc.identifier.pmid21288512-
dc.identifier.scopuseid_2-s2.0-79955364963en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79955364963&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume73en_US
dc.identifier.issue5en_US
dc.identifier.spage900en_US
dc.identifier.epage908en_US
dc.identifier.isiWOS:000290292800007-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridWong, TCL=22977955100en_US
dc.identifier.scopusauthoridWong, KT=34978071600en_US
dc.identifier.scopusauthoridChiu, PWY=7103182534en_US
dc.identifier.scopusauthoridTeoh, AYB=6602494653en_US
dc.identifier.scopusauthoridYu, SCH=8919477000en_US
dc.identifier.scopusauthoridAu, KWL=36854880900en_US
dc.identifier.scopusauthoridLau, JYW=13907867100en_US

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