Transcatheter Arterial Embolization for Bleeding Peptic Ulcers: A Multicenter Study

Spiliοpoulos, Stavros; Inchingolo, Riccardo; Lucatelli, Pierleone; Iezzi, Roberto; Διαμαντόπουλος, Αθανάσιος; Posa, Alessandro; Barry, Bryan; Ricci, Carmelo; Cini, Marco; Konstantos, Chrysostomos; Palialexis, Konstantinos; Reppas, Lazaros; Trikola, Artemis; Nardella, Michele; Adam, Andreas; Brountzos, Elias

doi:10.1007/s00270-018-1966-4

Cited by 19 publications

(22 citation statements)

References 16 publications

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“…The patient characteristics in the recently reported study by Lau et al are similar to the results of the present study considering the age and characteristics of the ulcer. In Asian trials, a predominance of male patients is reported; contrary to that, European studies report a proportion of gender similar to our results [9, 13, 14].…”

Section: Discussionsupporting

confidence: 86%

“…[9, 14]. Spiliopoulos et al reported a mean age of 74 years for patients undergoing TAE in their retrospective study [13]. The patient characteristics in the recently reported study by Lau et al are similar to the results of the present study considering the age and characteristics of the ulcer.…”

Section: Discussionsupporting

confidence: 85%

“…TAE has become popular in the treatment of non-variceal UGIB in the past two decades. It can be used as a bleeding control method in case of failed endoscopy or as a method to prevent recurrent bleeding after a successful primary endoscopic therapy [9, 13]. In this study, TAE was used as a preventive tool in patients at high risk of recurrent bleeding after primary endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The type, size, and localization of the ulcer are very important selection criteria [13]. The incidence of high-risk Forrest Ia, Ib, IIa, and IIb type ulcers is different in several reports.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background Upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding. Methods During the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups—P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed. Results From 738 patients with a bleeding peptic ulcer, 399 were at high risk for rebleeding after endoscopic hemostasis. From this cohort, 58 patients underwent P-TAE, and 341 were allocated to the EA. A significantly lower rebleeding rate was observed in the P-TAE group, 3.4% vs. 16.2% in the EA group; p = 0.005. The need for surgical intervention reached 10.3% vs. 20.6% in the P-TAE and EA groups accordingly; p = 0.065. Patients that underwent P-TAE required less FFP, 1.3 unit vs. 2.6 units in EA; p = 0.0001. The mortality rate was similar in groups with a tendency to decrease in the P-TAE group, 5.7% vs. 8.5% in EA; p = 0.417. Conclusion P-TAE is a feasible and safe procedure, and it may reduce the rebleeding rate and the need for surgical intervention in patients with a bleeding peptic ulcer when the rebleeding risk remains high after primary endoscopic hemostasis.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Randomized control trials comparing these options have showed that 93.1% of the patients who were treated surgically had long-term control of the bleeding compared to 73% of the patients who were treated endoscopically [ 6 ]. Transcatheter arterial embolization is a technically successful second-line treatment after failed endoscopy with a high clinical success rate [ 8 ]. However, a higher rebleeding rate when compared to surgery has been observed [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopically Assisted Laparoscopic Gastric Resection for Benign and Malignant Lesions: A Report of Two Cases

et al. 2018

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Case seriesPatient: Male, 67 • Female, 60Final Diagnosis: Gastric ulcer • early gastric cancerSymptoms: Upper gastrointestinal bleeding • atypical epigastric painMedication: —Clinical Procedure: Endoscopically assisted laparoscopic wedge gastric resectionSpecialty: SurgeryObjective:Educational purposeBackground:The first gastric resection for stomach cancer was performed in 1879, and the first gastric resection for gastric ulcer disease was performed in 1882. During the 1990s, the first laparoscopic gastrostomies were reported. During the past decade, laparoscopic techniques have developed rapidly, gaining wide clinical acceptance. Minimally invasive surgery is now shifting the balance away from traditional open methods. We report 2 cases of endoscopically assisted laparoscopic local gastric resections for both gastric cancer and gastric ulcer disease.Case Report:The first case involves a 67-year-old male patient who suffered from recurrent bleeding from a gastric ulcer located 4–5 cm from the gastroesophageal junction. The patient was subjected to endoscopically assisted laparoscopic wedge resection of the affected part of the stomach, had an uneventful recovery and was discharged on the third postoperative day. The second case involves a 60-year-old female patient who was diagnosed with intramucosal gastric adenocarcinoma and was also subjected to endoscopically assisted laparoscopic wedge gastrectomy. This patient also had an uneventful recovery and was discharged on the second postoperative day.Conclusions:Endoscopically assisted laparoscopic local gastric resection is a minimally invasive procedure which allows the surgeon to operate under direct visualization of the internal part of the stomach. Thus, it enables the surgeon to safely remove the affected part within healthy margins, providing the patient with all the advantages of laparoscopic surgery.

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Peptic ulcer disease

Cashin

Chung

2019

Textbook of Surgery

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Transcatheter Arterial Embolization for Bleeding Peptic Ulcers: A Multicenter Study

Abstract: TAE for the treatment of PUB was technically successful in all cases and resulted in high clinical success rate. Minimal re-bleeding rates further highlight the utility of TAE as the second line treatment of choice, after failed endoscopy.

Cited by 19 publications

References 16 publications

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

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

Endoscopically Assisted Laparoscopic Gastric Resection for Benign and Malignant Lesions: A Report of Two Cases

Peptic ulcer disease

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