Endoscopically unmanageable bleeding from duodenal ulcers: a job for the vascular surgeon or the interventional radiologist?

Loffroy, Romaric; Abualsaud, Basem; Cercueil, Jean-Pierre; Krausé, D.

doi:10.1016/j.amjsurg.2009.04.020

Cited by 2 publications

(1 citation statement)

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“…TAE may be considered as a method with good long-term results when endoscopic therapy is unavailable or unsuccessful, and a correction of coagulopathy before TAE is recommended; still, re-bleeding may happen in about 10% of patients [ 16 , 18 - 20 ]. Although TAE has been recognized as a possible alternative to endoscopic therapy and surgery, experts have issued warnings that the performance of TAE should be trusted to more experienced specialists [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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