Rockall Score Larger Than 7 as a Reliable Criterion for the Selection of Indications for Preventive Transarterial Embolization in a Subgroup of High-Risk Elderly Patients After Primary Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding

Abstract

BackgroundTransarterial embolization (TAE) is an alternative procedure to repeat endoscopy or surgical intervention in the case of re-bleeding after primary endoscopic treatment. The aim of the study was to assess the Rockall score as a criterion for TAE in the case of re-bleeding after endoscopic treatment of non-variceal upper gastrointestinal bleeding (NVUGIB).MethodsOut of the 673 patients who underwent emergent endoscopic hemostasis due to NVUGIB, 111 had a high risk of re-bleeding having a Forrest I-IIb ulcer and the Rockall score ≥ 5. From 111 patients, 37 accepted preventive TAE (PE+ group). The control group consisted of 74 patients who underwent standard treatment (PE- group).ResultsThere were no differences in the demographic status between both groups, nor in the main clinical data on admission. The performance of TAE resulted in a significantly lower re-bleeding rate (1 (4.8%) vs. 11 (33%), P = 0.018). No patient who underwent TAE with the Rockall score ≥ 7 required surgery, resulting in only one re-bleeding episode (P = 0.004). Mortality reached 5% and 11% in the PE+ and PE- groups accordingly.ConclusionThe Rockall score ≥ 7 could be a reliable predictor of re-bleeding after primary endoscopic hemostasis as one criterion for the selection of indications for preventive TAE.

Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience

“…The technical goal of P-TAE was the embolization of the left gastric artery or gastroduodenal artery (depending on the ulcer localization) within 24 h of endoscopic hemostasis, achieving a decrease of the arterial flow in the tissue beneath the ulcer. In cases with the ulcer localized in the smaller or greater curvature or the gastric fundus, the left gastric artery was obliterated; in cases of gastric antral, pyloric, or duodenal ulcers, the gastroduodenal artery was embolized [8, 12]. Rebleeding was defined as the presence of hematemesis, blood from the nasogastric tube, or melena associated with a fall in hemoglobin of more than 0.8 g/dl (not explained by hemodilution) or arterial hypotension after primary endoscopy.…”