Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial

Lau, James Y.; Pittayanon, Rapat; Wong, Kam-Fai; Pinjaroen, Nutcha; Chiu, Philip Wai Yan; Rerknimitr, Rungsun; Holster, Ingrid L.; Kuipers, Ernst J.; Wu, Kaichun; Au, Kim Wl; Chan, Francis K.L.; Sung, Joseph J.Y.

doi:10.1136/gutjnl-2018-316074

Cited by 50 publications

(73 citation statements)

References 18 publications

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“…Second, haemoglobin <90 g/L on admission was indicated for PAE in their study 1. A prospective cohort study did not find any significant differences of initial haemoglobin level between rebleeding and non-rebleeding peptic ulcers with Forrest classification higher than IIb 4.…”

mentioning

confidence: 83%

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Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications?

Tong

Lan

Tang

2019

Gut

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mentioning

confidence: 83%

“…We have read with great interest the paper by Lau et al ,1 which reported that prophylactic angiographic embolisation (PAE) did not reduce recurrent bleeding after endoscopic haemostasis in peptic ulcers.…”

mentioning

confidence: 99%

Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications?

Tong

Lan

Tang

2019

Gut

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“…Prophylactic transarterial embolization of high risk ulcers after endoscopic therapy is not recommended: it did not significantly reduce rebleeding when compared with standard treatment (10.2% v 11.4%) in an RCT of 241 patients 116…”

Section: Management Of Persistent or Recurrent Bleeding Including Romentioning

confidence: 96%

Management of acute upper gastrointestinal bleeding

Stanley

Laine

2019

BMJ

155

133

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Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

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“…There are insufficient highlevel data to draw firm conclusions. -As a planned intervention, in association with endoscopic control: The addition of prophylactic embolization in addition to endoscopic hemostasis has been investigated by several authors, including most recently with two randomized controlled trials [143,144]. Laursen et al demonstrated a trend toward improved outcomes in patients who underwent additional prophylactic embolization.…”

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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Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: a randomised controlled trial

Abstract: NCT01142180.

Cited by 50 publications

References 18 publications

Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications?

Prophylactic angiographic embolisation after endoscopic treatment of bleeding for high-risk peptic ulcers: what are the more appropriate indications?

Management of acute upper gastrointestinal bleeding

Perforated and bleeding peptic ulcer: WSES guidelines

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