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Transcatheter Arterial Embolization Compared With Surgery for Uncontrolled Peptic Ulcer Bleeding

A Population-based Cohort Study

Sverdén, Emma, MD, PhD*,†; Mattsson, Fredrik, BSc*; Lindström, David, MD, PhD; Sondén, Anders, MD, PhD; Lu, Yunxia, MD, PhD*,§; Lagergren, Jesper, MD, PhD*,‡,¶

doi: 10.1097/SLA.0000000000002565
ORIGINAL ARTICLES

Objective: To compare key outcomes after transcatheter arterial embolization (TAE) with conventional surgery for peptic ulcer bleeding when endoscopic intervention fails to achieve hemostasis.

Background: Mortality in peptic ulcer bleeding remains high, especially in patients who require surgical treatment.

Methods: A population-based cohort study in Stockholm, Sweden, in 2000 to 2014, assessing the main outcome all-cause mortality and the secondary outcomes re-bleeding, re-intervention, length of hospitalization, and complications, was conducted. Data were taken from well-maintained registries and medical records. Multivariable Cox-regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, ulcer history, comorbidity, and calendar period were considered.

Results: Included were 282 patients, 97 in the TAE group and 185 in the surgery group. Compared with the surgery group, the overall hazard of death was 34% decreased in the TAE group (adjusted HR 0.66, 95% CI 0.46–0.96). The corresponding HRs for mortality within 30 days, 90 days, 1 year, and 5 years were 0.70 (95% CI 0.37–1.35), 0.69 (95% CI 0.38–1.26), 0.88 (95% CI 0.53–1.47), and 0.67 (95% CI 0.45–1.00), respectively. The risk of re-bleeding was higher after TAE compared with surgery (HR 2.48, 95% CI 1.33–4.62). The median length of hospital stay was shorter in the TAE group—8 versus 16 days—acceleration factor 0.59 (95% CI 0.45–0.77) and the risk of complications was lower (8.3% vs 32.2%; P < 0.0001).

Conclusions: 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 higher risk of re-bleeding. TAE could be recommended as first-line treatment for these patients.

*Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden

Vascular Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

§Program in Public Health, College of Health Sciences, University of California, Irvine, CA

Division of Cancer Studies, King's College London, and Guy's and St Thomas’ NHS Foundation Trust, UK.

Reprints: Emma Sverdén, MD, PhD, Department of Upper Gastrointestinal Surgery, South Hospital Stockholm, SE-188 83, Sweden. E-mail: emma.s.eklund@gmail.com.

Author contributions: Study concept and design—ES, YL, and JL; acquisition of data—all authors; analysis and interpretation of data—all authors; drafting of the manuscript—ES; critical revision of the manuscript for important intellectual content—all authors; statistical analysis—FM; obtained funding—JL. All authors have approved of the final submitted draft.

Funding: This work was supported by the Swedish Research Council (grant number D0547801). The grant provider did not participate to any degree in the study.

None of the authors have any conflicts of interest regarding this study.

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