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Transcatheter Arterial Embolization for Bleeding Peptic Ulcers: A Multicenter Study

  • Clinical Investigation
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Abstract

Purpose

To investigate the outcomes of transcatheter arterial embolization (TAE) for the treatment of peptic ulcer bleeding (PUB).

Materials and Methods

This is a retrospective, multicenter study, which investigated all patients who underwent TAE for the treatment of severe upper gastrointestinal hemorrhage from peptic ulcers in five European centers, between January 1, 2012 and May 1, 2017. All patients had undergone failed endoscopic hemostasis. Forty-four patients (male; mean age 74.0 ± 11.1 years, range 49–94), with bleeding from duodenum (36/44; 81.8%) or gastric ulcer (8/44; 18.2%) were followed up to 3.5 years (range 2–1354 days). In 42/44 cases, bleeding was confirmed by pre-procedural CT angiography. In 50% of the cases, coils were deployed, while in the remaining glue, microparticles, gel foam and combinations of the above were used. The study’s outcome measures were 30-day survival technical success (occlusion of feeding vessel and/or no extravasation at completion DSA), overall survival, bleeding relapse and complication rates.

Results

The technical success was 100%. The 30-day survival rate was 79.5% (35/44 cases). No patients died due to ongoing or recurrent hemorrhage. Re-bleeding occurred in 2/44 cases (4.5%) and was successfully managed with repeat TAE (one) or surgery (one). The rate of major complications was 4.5% (2/44; one acute pancreatitis and one partial pancreatic ischemia), successfully managed conservatively. According to Kaplan–Meier analysis survival was 71.9% at 3.5 years.

Conclusions

TAE for the treatment of PUB was technically successful in all cases and resulted in high clinical success rate. Minimal re-bleeding rates further highlight the utility of TAE as the second line treatment of choice, after failed endoscopy.

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References

  1. Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. N Engl J Med. 2008;359(9):928–37.

    Article  PubMed  CAS  Google Scholar 

  2. Lee CW, Sarosi GA Jr. Emergency ulcer surgery. Surg Clin North Am. 2011;91(5):1001–13.

    Article  PubMed  Google Scholar 

  3. Abe N, Takeuchi H, Yanagida O, Sugiyama M, Atomi Y. Surgical indications and procedures for bleeding peptic ulcer. Dig Endosc. 2010;22(Suppl 1):S35–7.

    Article  PubMed  Google Scholar 

  4. Kyaw M, Tse Y, Ang D, Ang TL, Lau J. Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis. Endosc Int Open. 2014;2(1):E6–14.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993–2006. Ann Surg. 2010;251(1):51–8.

    Article  PubMed  Google Scholar 

  6. Sverdén E, Mattsson F, Lindström D, Sondén A, Lu Y, Lagergren J. Transcatheter arterial embolization compared with surgery for uncontrolled peptic ulcer bleeding: a population-based cohort study. Ann Surg. 2017. https://doi.org/10.1097/sla.0000000000002565.

    Article  PubMed  Google Scholar 

  7. Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10):a1–46.

    Article  PubMed  Google Scholar 

  8. Wong TCF, Wong TT, Chiu PWY, et al. A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers. Gastrointest Endosc. 2011;73:900–8.

    Article  PubMed  Google Scholar 

  9. Beggs AD, Dilworth MP, Powell SL, et al. A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding. Clin Exp Gastroenterol. 2014;7:93–104.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Loggers SAI, Koedam TWA, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. Eur J Trauma Emerg Surg. 2017;43(6):823–33.

    Article  PubMed  CAS  Google Scholar 

  11. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6.

    Article  CAS  Google Scholar 

  12. Ichiro I, Shushi H, Akihiko I, Yasuhiko I, Yasuyuki Y. Empiric transcatheter arterial embolization for massive bleeding from duodenal ulcers: efficacy and complications. J Vasc Interv Radiol. 2011;22(7):911–6.

    Article  PubMed  Google Scholar 

  13. Laffroy Lin M, Thompson C, Harsha A, Rao P. A comparison of the results of arterial embolization for bleeding and non-bleeding gastroduodenal ulcers. Acta Radiol. 2011;152(10):1076–82.

    Article  Google Scholar 

  14. Wang YL, Cheng YS, Liu LZ, He ZH, Ding KH. Emergency transcatheter arterial embolization for patients with acute massive duodenal ulcer hemorrhage. World J Gastroenterol. 2012;18:4765–70.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Loffroy R. Management of duodenal ulcer bleeding resistant to endoscopy: surgery is dead! World J Gastroenterol. 2013;19(7):1150–1.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Loffroy R, Guiu B. Role of transcatheter arterial embolization for massive bleeding from gastroduodenal ulcers. World J Gastroenterol. 2009;15:5889–97.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece

    Stavros Spiliopoulos, Chrysostomos Konstantos, Konstantinos Palialexis, Lazaros Reppas, Artemis Trikola & Elias Brountzos

  2. Department of Radiological Sciences, Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy

    Riccardo Inchingolo, Roberto Iezzi & Alessandro Posa

  3. Institute of Radiology, Madonna delle Grazie Hospital, Matera, Italy

    Riccardo Inchingolo & Michele Nardella

  4. Vascular Interventional Radiology Unit, University of Siena, Viale Mario Bracci 53, 53100, Siena, Italy

    Pierleone Lucatelli, Carmelo Ricci & Marco Cini

  5. Department of Interventional Radiology, Guy’s and St Thomas’ Hospitals, NHS Foundation Trust, London, UK

    Athanasios Diamantopoulos, Bryan Barry & Andreas Adam

Authors
  1. Stavros Spiliopoulos
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  2. Riccardo Inchingolo
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  3. Pierleone Lucatelli
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  4. Roberto Iezzi
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  5. Athanasios Diamantopoulos
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  6. Alessandro Posa
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  7. Bryan Barry
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  8. Carmelo Ricci
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  9. Marco Cini
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  10. Chrysostomos Konstantos
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  11. Konstantinos Palialexis
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  12. Lazaros Reppas
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  13. Artemis Trikola
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  14. Michele Nardella
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  15. Andreas Adam
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  16. Elias Brountzos
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Corresponding author

Correspondence to Stavros Spiliopoulos.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Procedural informed consent was obtained from all individual participants included in the study.

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Spiliopoulos, S., Inchingolo, R., Lucatelli, P. et al. Transcatheter Arterial Embolization for Bleeding Peptic Ulcers: A Multicenter Study. Cardiovasc Intervent Radiol 41, 1333–1339 (2018). https://doi.org/10.1007/s00270-018-1966-4

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  • DOI: https://doi.org/10.1007/s00270-018-1966-4

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