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Emergency Radiology

, Volume 15, Issue 6, pp 413–419 | Cite as

Acute upper gastrointestinal hemorrhage: is a radiological interventional approach an alternative to emergency surgery?

  • I. Langner
  • S. LangnerEmail author
  • L. I. Partecke
  • A. Glitsch
  • M. Kraft
  • W. v. Bernstorff
  • N. Hosten
Original Article

Abstract

The aim of our study was to discuss the option of endovascular treatment compared to surgery for patients with endoscopically unmanageable nonvariceal hemorrhage of the upper gastrointestinal tract. From 2000 to 2006, 23 patients (male, 15 male; female, 8; mean age, 69 years) who failed endoscopic therapy for upper gastrointestinal hemorrhage were retrospectively evaluated. Twelve patients were operated on (SG), whereas 11 patients had an endovascular intervention (IG). Technical and primary clinical success rates and complications rates were calculated. Clinical parameters and comorbidities were related to outcome. The surgical group suffered less frequently from pre-existing pulmonary diseases (SG, 17%; IG, 55%; p = 0.05) and had a higher incidence of shock requiring catecholamines (p < 0.01) or plasma expander therapy (p < 0.01). There was no significant difference in the incidence of recurrent bleeding episodes (SG, 17%; IG, 27%; p = 0.35) and mortality rates (SG, 17%; IG, 27%, p = 0.35). Deaths in the IG were due to recurrent bleeding. In patients with unsuccessful endoscopic control of nonvariceal bleeding of the upper GI tract, surgery remains a very effective treatment. However, in patients with a high surgical risk due to unknown bleeding sources and/or severe pre-existing diseases/comorbidities, endovascular therapy offers an excellent treatment option. These patients should then be operated on as early as possible to minimize the risk of recurrent bleeding episodes, which are associated with high morbidity and mortality.

Keywords

Interventional Radiography Gastrointestinal Hemorrhage Surgery 

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Copyright information

© Am Soc Emergency Radiol 2008

Authors and Affiliations

  • I. Langner
    • 1
  • S. Langner
    • 2
    Email author
  • L. I. Partecke
    • 1
  • A. Glitsch
    • 1
  • M. Kraft
    • 3
  • W. v. Bernstorff
    • 1
  • N. Hosten
    • 2
  1. 1.Department of SurgeryErnst-Moritz-Arndt-University GreifswaldGreifswaldGermany
  2. 2.Institute for Diagnostic Radiology and NeuroradiologyErnst-Moritz-Arndt-University GreifswaldGreifswaldGermany
  3. 3.Department of Internal MedicineErnst-Moritz-Arndt-University GreifswaldGreifswaldGermany

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