Bleeding gastric and duodenal ulcers: case-control study comparing angioembolization and surgery

Nykänen, Taina; Peltola, Erno; Kylänpää, Leena; Udd, Marianne

doi:10.1080/00365521.2017.1288756

Cited by 36 publications

(44 citation statements)

References 31 publications

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“…For surgical salvage therapy, reported rates of rebleeding, complications, and mortality are 6.8% to 23.0%, 63.0% to 68.0%, and 18.0% to 25.0%, respectively. 6,5,[31][32][33] Although there is a lack of RCTs, TAE is associated with similar rebleeding and mortality rates (25.0%-29.0% and 12.5%-20.8%), but complication rates are reported to be lower than those of surgery (37.5%-40.6%). 6,5,[31][32][33] In our study, 30-day recurrent bleeding rate, complication rate, and mortality were 12.9%, 15.1%, and 12.1% in the OTSC group.…”

Section: Discussionmentioning

confidence: 99%

“…The latter is associated with a mortality of between 14% and 29% and high complication rates. 2,5,6 Very likely, improvement of endoscopic hemostasis for recurrent bleeding directly impacts clinical outcome. Although injection of diluted adrenaline only is not adequate for hemostasis, combination with through-the-scope clips (TTSCs) or thermal methods is considered to be the standard endoscopic therapy.…”

Section: Sting Studymentioning

confidence: 99%

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Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Sting Studymentioning

confidence: 99%

Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers

et al. 2018

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“…Beggs et al included 9 cohort studies (8 retrospective and 1 prospective), and similarly concluded that surgery was associated with a significantly lower risk of rebleeding, and only a marginal trend towards increased mortality. Subsequent to these first two meta-analyses, a case-control study comparing angioembolization with surgery [138] reported a trend to higher rebleeding rates following angioembolization, and a trend towards higher mortality after surgery was seen. A significantly lower rate of post-procedural complications was reported in the angioembolization cohort.…”

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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“…In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and 2 (1-3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

et al. 2018

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ObjectivesThis study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement.DesignNational cohort study using National Emergency Laparotomy Audit (NELA) data.SettingEnglish and Welsh hospitals within the National Health Service.ParticipantsAdult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015.InterventionsLaparotomy for bleeding or perforated peptic ulcer.Primary and secondary outcome measuresThe primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate.Results2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7–17) and 2 (1–3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach.ConclusionsPatients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.

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Bleeding gastric and duodenal ulcers: case-control study comparing angioembolization and surgery

Abstract: Mortality and rebleeding rates did not differ between TAE and surgery. With less postoperative complications, TAE should be the preferred hemostatic method when endoscopy fails.

Cited by 36 publications

References 31 publications

Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers

Over-the-Scope Clips Are More Effective Than Standard Endoscopic Therapy for Patients With Recurrent Bleeding of Peptic Ulcers

Perforated and bleeding peptic ulcer: WSES guidelines

Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study

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