Early angiographic embolization is more effective than delayed angiographic embolization in patients with duodenal ulcer bleeding

Lee, Seok; Kim, Sang Wook; Moon, Jin Chang; Jang, Jin-Wook; Kim, Heyoung Il; Park, Won Seok; Jeon, Byung Jun; Sohn, Jungwoo; Kim, Seong Hun; Kim, In Hee; Lee, Seung Ok; Lee, Soo Teik

doi:10.1111/j.1440-1746.2012.07239.x

Cited by 8 publications

(4 citation statements)

References 15 publications

(13 reference statements)

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“…Elevated PT was identified as another independent risk factor for DL rebleeding. Prolonged PT indicates deranged coagulation function and could be the reason for the secondary rebleeding from the site of endoscopic clipping or injection therapy [20]. Hence, for such patients, and along with endoscopic therapy, the coagulation profile should be corrected by stopping the anticoagulants, especially when the patient is taking any of these, and administering fresh frozen plasma.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion

Lai

Rong

Zhu

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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Background and Objective: Dieulafoy lesion is a rare, but life-threatening, cause of gastrointestinal hemorrhage, and endoscopic therapy is the preferred first-line treatment. The present study aims to analyze the risk factors for rebleeding after endoscopic hemostasis of gastroduodenal Dieulafoy lesion. Methods. A retrospective review of patients with Dieulafoy lesion who developed acute gastrointestinal bleeding and were treated primarily with endoscopic therapy from September 2014 to April 2019 was conducted. Results. A total of 133 patients with Dieulafoy lesion were included in the present study. The mean age of these patients was 56.05 ± 16.58 years, and 115 patients were male. Among these 133 patients, 26 patients developed rebleeding within 30 days of endoscopic therapy. The 30-day rebleeding rate for pure injection therapy (epinephrine, cyanoacrylate, or lauromacrogol injection alone), nonpure injection therapy (argon plasma coagulation, band ligation, and hemoclip application alone), and combination therapy (combination of any >2 methods) was 45.2%, 12.8%, and 11%, respectively. In the univariable analysis, endoscopic treatment, prothrombin time, gender, Rockall score, and leukocyte count were the risk factors for rebleeding. In the multivariable analysis, pure injection endoscopic treatment, white blood cells (>10 × 109/L), and prothrombin time >12 seconds were the independent risk factors for rebleeding. Conclusion. Patients who undergo pure injection endoscopic treatment and have a high leukocyte count (>10 × 109/L) or elevated prothrombin time (>12 seconds) have an increased risk of rebleeding within 30 days after endoscopic treatment for gastroduodenal Dieulafoy lesion. Combined endoscopic treatment is the most effective therapy to prevent rebleeding in gastroduodenal Dieulafoy lesion.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion

Lai

Rong

Zhu

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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“…Hence, hematemesis and shock scored more in the nomogram. Prolonged PT indicates deranged coagulation function and was another valuable predictor for rebleeding in patients presenting with PUB [ 30 ]. For patients with prolonged PT, the doctor should pay more attention to or take an extra intervention.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding

Lai

Zhu

et al. 2022

BMC Gastroenterol

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Background Peptic ulcer bleeding remains a typical medical emergency with significant morbidity and mortality. Peptic ulcer rebleeding often occurs within three days after emergent endoscopic hemostasis. Our study aims to develop a nomogram to predict rebleeding within three days after emergent endoscopic hemostasis for high-risk peptic ulcer bleeding. Methods We retrospectively reviewed the data of 386 patients with bleeding ulcers and high-risk stigmata who underwent emergent endoscopic hemostasis between March 2014 and October 2018. The least absolute shrinkage and selection operator method was used to identify predictors. The model was displayed as a nomogram. Internal validation was carried out using bootstrapping. The model was evaluated using the calibration plot, decision-curve analyses, and clinical impact curve. Results Overall, 386 patients meeting the inclusion criteria were enrolled, with 48 patients developed rebleeding within three days after initial endoscopic hemostasis. Predictors contained in the nomogram included albumin, prothrombin time, shock, haematemesis/melena and Forrest classification. The model showed good discrimination and good calibration with a C-index of 0.854 (C-index: 0.830 via bootstrapping validation). Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable. Conclusion This study presents a nomogram that incorporates clinical, laboratory, and endoscopic features, effectively predicting rebleeding within three days after emergent endoscopic hemostasis and identifying high-risk rebleeding patients with peptic ulcer bleeding. Trial registration This clinical trial has been registered in the ClinicalTrials.gov (ID: NCT04895904) approved by the International Committee of Medical Journal Editors (ICMJE).

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“…In a series of 54 patients with bleeding duodenal ulcer, Lee et al identified a lower incidence of mortality and need for ICU care among patients that underwent early TAE. [ 20 ] The association between early TAE and mortality requires further investigations. In consideration of the impact of extravasation during angiography on clinical outcomes after TAE, Choi et al reported the incidence of clinical failure and 30-day all-cause mortality was significantly higher in patients with extravasation noted during angiography.…”

Section: Discussionmentioning

confidence: 99%

Gastroduodenal artery embolization for peptic ulcer hemorrhage refractory to endoscopic intervention: A single-center experience

Khazi

Marjara

Nance

et al. 2022

JCIS

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Objective To determine the efficacy of gastroduodenal artery embolization (GDAE) for bleeding peptic ulcers that failed endoscopic intervention. To identify incidence and risk factors for failure of GDAE. Materials and Methods A retrospective review of patients who underwent GDAE for hemorrhage from peptic ulcer disease refractory to endoscopic intervention were included in the study. Refractory to endoscopic intervention was defined as persistent hemorrhage following at least two separate endoscopic sessions with two different endoscopic techniques (thermal, injection, or mechanical) or one endoscopic session with the use of two different techniques. Demographics, comorbidities, endoscopic and angiographic findings, significant post-embolization pRBC transfusion, and index GDAE failure were collected. Failure of index GDAE was defined as the need for re-intervention (repeat embolization, endoscopy, or surgery) for rebleeding or mortality within 30 days after GDAE. Multivariate analyzes were performed to identify independent predictors for failure of index GDAE. Results There were 70 patients that underwent GDAE after endoscopic intervention for bleeding peptic ulcers with a technical success rate of 100%. Failure of index GDAE rate was 23% (n = 16). Multivariate analysis identified ≥2 comorbidities (odds ratio [OR]: 14.2 [1.68-19.2], P = 0.023), days between endoscopy and GDAE (OR: 1.43 [1.11-2.27], P = 0.028), and extravasation during angiography (OR: 6.71 [1.16-47.4], P = 0.039) as independent predictors of index GDAE failure. Endoscopic Forrest classification was not a significant predictor for the failure of index GDAE (P > 0.1). Conclusion The study demonstrates safety and efficacy of GDAE for hemorrhage from PUD that is refractory to endoscopic intervention. Days between endoscopy and GDAE, high comorbidity burden, and extravasation during angiography are associated with increased risk for failure of index GDAE.

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Early angiographic embolization is more effective than delayed angiographic embolization in patients with duodenal ulcer bleeding

Abstract: When the AE was performed early with correction for prolonged PT, the patients with duodenal ulcer bleeding had a more favorable prognosis.

Cited by 8 publications

References 15 publications

Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion

Risk Factors for Rebleeding after Emergency Endoscopic Treatment of Dieulafoy Lesion

Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding

Gastroduodenal artery embolization for peptic ulcer hemorrhage refractory to endoscopic intervention: A single-center experience

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