Emma Sverdén1,2, Fredrik Mattsson1, David Lindström3, Anders Sondén2, Yunxia Lu1,4, Jesper Lagergren1,3,5. 1. Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 2. Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden. 3. Vascular Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 4. Program in Public Health, College of Health Sciences, University of California, Irvine, CA. 5. Division of Cancer Studies, King's College London, and Guy's and St Thomas' NHS Foundation Trust, UK.
Abstract
OBJECTIVE: To compare key outcomes after transcatheter arterial embolization (TAE) with conventional surgery for peptic ulcer bleeding when endoscopic intervention fails to achieve hemostasis. BACKGROUND: Mortality in peptic ulcer bleeding remains high, especially in patients who require surgical treatment. METHODS: A population-based cohort study in Stockholm, Sweden, in 2000 to 2014, assessing the main outcome all-cause mortality and the secondary outcomes re-bleeding, re-intervention, length of hospitalization, and complications, was conducted. Data were taken from well-maintained registries and medical records. Multivariable Cox-regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, ulcer history, comorbidity, and calendar period were considered. RESULTS: Included were 282 patients, 97 in the TAE group and 185 in the surgery group. Compared with the surgery group, the overall hazard of death was 34% decreased in the TAE group (adjusted HR 0.66, 95% CI 0.46-0.96). The corresponding HRs for mortality within 30 days, 90 days, 1 year, and 5 years were 0.70 (95% CI 0.37-1.35), 0.69 (95% CI 0.38-1.26), 0.88 (95% CI 0.53-1.47), and 0.67 (95% CI 0.45-1.00), respectively. The risk of re-bleeding was higher after TAE compared with surgery (HR 2.48, 95% CI 1.33-4.62). The median length of hospital stay was shorter in the TAE group-8 versus 16 days-acceleration factor 0.59 (95% CI 0.45-0.77) and the risk of complications was lower (8.3% vs 32.2%; P < 0.0001). CONCLUSIONS: This study indicates that TAE compares favorably with surgery regarding prognosis after refractory peptic ulcer bleeding, and the shorter length of hospital stay and fewer complications outweigh a higher risk of re-bleeding. TAE could be recommended as first-line treatment for these patients.
OBJECTIVE: To compare key outcomes after transcatheter arterial embolization (TAE) with conventional surgery for peptic ulcer bleeding when endoscopic intervention fails to achieve hemostasis. BACKGROUND: Mortality in peptic ulcer bleeding remains high, especially in patients who require surgical treatment. METHODS: A population-based cohort study in Stockholm, Sweden, in 2000 to 2014, assessing the main outcome all-cause mortality and the secondary outcomes re-bleeding, re-intervention, length of hospitalization, and complications, was conducted. Data were taken from well-maintained registries and medical records. Multivariable Cox-regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, ulcer history, comorbidity, and calendar period were considered. RESULTS: Included were 282 patients, 97 in the TAE group and 185 in the surgery group. Compared with the surgery group, the overall hazard of death was 34% decreased in the TAE group (adjusted HR 0.66, 95% CI 0.46-0.96). The corresponding HRs for mortality within 30 days, 90 days, 1 year, and 5 years were 0.70 (95% CI 0.37-1.35), 0.69 (95% CI 0.38-1.26), 0.88 (95% CI 0.53-1.47), and 0.67 (95% CI 0.45-1.00), respectively. The risk of re-bleeding was higher after TAE compared with surgery (HR 2.48, 95% CI 1.33-4.62). The median length of hospital stay was shorter in the TAE group-8 versus 16 days-acceleration factor 0.59 (95% CI 0.45-0.77) and the risk of complications was lower (8.3% vs 32.2%; P < 0.0001). CONCLUSIONS: This study indicates that TAE compares favorably with surgery regarding prognosis after refractory peptic ulcer bleeding, and the shorter length of hospital stay and fewer complications outweigh a higher risk of re-bleeding. TAE could be recommended as first-line treatment for these patients.
Authors: Armin Kuellmer; Tobias Mangold; Dominik Bettinger; Lars Maruschke; Andreas Wannhoff; Karel Caca; Edris Wedi; Ali Seif Amir Hosseini; Tobias Kleemann; Thomas Schulz; Carlo Jung; Robert Thimme; Arthur Schmidt Journal: United European Gastroenterol J Date: 2021-08-25 Impact factor: 4.623