Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis

Kyaw, Moe H.; Tse, Yee Kit; Ang, Daphne; Ang, Tiing Leong; Lau, James

doi:10.1055/s-0034-1365235

Cited by 50 publications

(40 citation statements)

References 36 publications

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“…One prospective and multiple retrospective cohort studies comparing outcomes between patients undergoing angioembolization with those undergoing surgery for rebleeding after failed endoscopic control are available. These studies were summarized in three meta-analysis [135][136][137]. Kyaw et al summarized 6 retrospective cohort studies: surgery was found to significantly reduce the likelihood of further (post-intervention) hemorrhage, and was associated with a trend towards a reduced need for further intervention.…”

Section: Angiography Embolizationmentioning

confidence: 99%

Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.

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Section: Angiography Embolizationmentioning

confidence: 99%

Perforated and bleeding peptic ulcer: WSES guidelines

et al. 2020

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“…In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and 2 (1-3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

et al. 2018

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ObjectivesThis study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement.DesignNational cohort study using National Emergency Laparotomy Audit (NELA) data.SettingEnglish and Welsh hospitals within the National Health Service.ParticipantsAdult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015.InterventionsLaparotomy for bleeding or perforated peptic ulcer.Primary and secondary outcome measuresThe primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate.Results2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7–17) and 2 (1–3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.ConclusionsPatients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.

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“…A recent study indicated that arterial embolization had become a first-line option when managing acute GIB that is refractory to endoscopic hemostasis and surgery. 7,8 Furthermore, a recent systematic review reported that REBOA successfully elevated central blood pressure in patients with hemorrhagic shock in various clinical settings. 13 In this study, three patients (one trauma and two nontrauma patients) underwent REBOA in the ED that was performed by residents trained in femoral sheath insertion by trained acute care specialists.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, an AVIRT procedure was performed in cases of nonvariceal gastrointestinal bleeding (GIB) when an emergency endoscopy failed or when the site of bleeding was difficult to access (e.g., small intestine or colon). 7,8 We routinely performed vascular evaluations using contrast-enhanced CT scans. Furthermore, when angiography showed CM extravasations or pseudoaneurysms from arterial injuries, a trained acute care specialist performed a therapeutic AVIRT.…”

Section: Methodsmentioning

confidence: 99%

Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists

Tsurukiri¹,

Ohta

Mishima³

et al. 2017

Journal of Trauma and Acute Care Surgery

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INTRODUCTIONComprehensive treatment of a patient in acute medicine and surgery requires the use of both surgical techniques and other treatment methods. Recently, acute vascular interventional radiology techniques (AVIRTs) have become increasingly popular, enabling adequately trained in-house experts to improve the quality of on-site care.METHODSAfter obtaining approval from our institutional ethics committee, we conducted a retrospective study of AVIRT procedures performed by acute care specialists trained in acute medicine and surgery over a 1-year period, including those conducted out of hours. Trained acute care specialists were required to be certified by the Japanese Association of Acute Medicine and to have completed at least 1 year of training as a member of the endovascular team in the radiology department of another university hospital. The study was designed to ensure that at least one of the physicians was available to perform AVIRT within 1 h of a request at any time. Femoral sheath insertion was usually performed by the resident physicians under the guidance of trained acute care specialists.RESULTSThe study sample comprised 77 endovascular procedures for therapeutic AVIRT (trauma, n = 29, and nontrauma, n = 48) among 62 patients (mean age, 64 years; range, 9–88 years), of which 55% were male. Of the procedures, 47% were performed out of hours (trauma, 52%; and nontrauma, 44%). Three patients underwent resuscitative endovascular balloon occlusion of the aorta in the emergency room. No major device-related complications were encountered, and the overall mortality rate within 60 days was 8%. The recorded causes of death included exsanguination (n = 2), pneumonia (n = 2), sepsis (n = 1), and brain death (n = 1).CONCLUSIONWhen performed by trained acute care specialists, AVIRT seems to be advantageous for acute on-site care and provides good technical success. Therefore, a standard training program should be established for acute care specialists or trauma surgeons to make these techniques a part of the standard regimen.LEVEL OF EVIDENCETherapy/care management study, level V.

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Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis

Cited by 50 publications

References 36 publications

Perforated and bleeding peptic ulcer: WSES guidelines

Perforated and bleeding peptic ulcer: WSES guidelines

Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists

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