Transarterial embolization an effective alternative to endoscopy for acute peptic ulcer bleeding

Study compares transarterial embolization to surgery in patients whose bleeding had not been controlled by endoscopy

Researchers from China report that in patients with peptic ulcer bleeding in whom endoscopy failed to control the bleeding, transarterial embolization is a safe procedure which reduces the need for surgery without increasing overall mortality and is associated with few complications. The study appears in the May issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

A peptic ulcer is an erosion in the lining of the stomach or the first part of the small intestine, called the duodenum. Normally, the lining of the stomach and small intestines are protected against the irritating acids produced in the stomach. If this protective lining stops working correctly, and the lining breaks down, it may result in inflammation (gastritis) or an ulcer. Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Despite improvements in medical and endoscopic therapies for ulcers, bleeding may continue or recur in 13 percent of patients after endoscopic treatment for their bleeding peptic ulcers. Continued bleeding after initial treatment often leads to a need for surgery, but the surgery is associated with a high morbidity rate (55 percent) and a high mortality rate (30 percent). Transarterial embolization (TAE) has been proposed as an alternative to this type of surgery. Angiography with TAE provides a nonoperative option for patients whose acute peptic ulcer bleeding has not been controlled by endoscopy. Embolization is a treatment that clogs small blood vessels and blocks the flow of blood, and agents used for this purpose include Gelfoam, polyvinyl alcohol, cyanoacrylic glues, and coils. Primary technical success rates range between 52 percent and 98 percent, with recurrent bleeding requiring repeated embolization procedures in approximately 10 percent to 20 percent of patients.

"In our study, we set out to compare the outcomes of transarterial embolization and salvage surgery for patients with peptic ulcers in whom endoscopic hemostasis failed," said study lead author Tiffany Cho-Lam Wong, The Institute of Digestive Disease, The Chinese University Hong Kong. "We found TAE is a safe procedure with a high technical success rate. In those with gastroduodenal ulcer bleeding in whom endoscopic hemostasis failed, TAE reduces the need for surgery and the overall complications, and accomplishes this without increasing the overall mortality."