Transcatheter approach may best surgery for peptic ulcer bleeding

Last Updated: 2017-11-16

By Reuters Staff

NEW YORK (Reuters Health) - Transcatheter arterial embolization (TAE) can be offered as a first-line treatment for patients with uncontrolled peptic ulcer bleeding, the authors of a population-based cohort study from Sweden conclude.

"This study indicates that TAE compares favorably with surgery regarding prognosis after refractory peptic ulcer bleeding, and the shorter length of hospital stay and fewer complications outweigh a high risk of bleeding," Dr. Emma Sverden of the Karolinska Institute in Stockholm and colleagues write.

Endoscopic treatment of peptic ulcer succeeds more than 90% of the time, Dr. Sverden and her team note in their October 23 online report in Annals of Surgery. Continued bleeding or rebleeding is typically treated with surgery, but postoperative mortality risk ranges from 8% to 33%.

Introduced in the 1970s, TAE is increasingly accepted as an alternative to surgery. Studies comparing TAE with surgery suggest that TAE is a safe option, the researchers say, but the statistical power of the existing research is low.

The new study compared TAE with surgery in all patients with refractory bleeding ulcers treated in Stockholm from 2000 through 2014. Of 282 study participants, 97 had TAE and 185 had surgery. Most characteristics of the two groups were similar, although the TAE patients were more likely to be on antithrombotic drugs (21.6% vs. 8.1%). Mean follow-up was 3.3 years for the TAE group and 3.7 years for the surgery group.

The adjusted hazard ratio (aHR) for all-cause mortality was 0.66 for patients who had TAE compared to those treated surgically, a significant difference.

The mortality advantage of TAE over surgery was even better in patients who had no history of ulcers (aHR, 0.64), those with a Charlson score of at least 2 (aHR, 0.60), those younger than the median age (aHR, 0.54), hypotensive patients (aHR, 0.49), and patients with tachycardia (aHR, 0.62).

In contrast, TAE was associated with significantly higher aHRs for rebleeding (2.48) and need for hemostatic treatment (5.41).

The TAE group spent an average of eight days in the hospital, versus 16 days for the surgery group. Postoperative complications occurred in 8.3% and 32.2%, respectively.

"This large and population-based cohort study with complete and long follow-up, and adjustment for confounding, indicates a better prognosis in patients undergoing TAE compared with surgery after peptic ulcer bleeding where endoscopic intervention fails to achieve hemostasis," the authors conclude."

Dr. Sverden was not available for an interview by press time.

SOURCE: http://bit.ly/2z0axEQ

Ann Surg 2017.