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Küllmer, Armin [Author]; Mangold, Tobias [Author]; Bettinger, Dominik [Author]; Maruschke, Lars [Author]; Wannhoff, Andreas [Author]; Caca, Karel [Author]; Wedi, Edris [Author]; Hosseini, Ali Seif Amir [Author]; Kleemann, Tobias [Author]; Schulz, Thomas [Author]; Jung, Carlo [Author]; Thimme, Robert [Author]; Schmidt, Arthur [Author]

Over-the-scope clip versus transcatheter arterial embolization for refractory peptic ulcer bleeding

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  • Media type: E-Article
  • Title: Over-the-scope clip versus transcatheter arterial embolization for refractory peptic ulcer bleeding : a propensity score matched analysis
  • Contributor: Küllmer, Armin [Author]; Mangold, Tobias [Author]; Bettinger, Dominik [Author]; Maruschke, Lars [Author]; Wannhoff, Andreas [Author]; Caca, Karel [Author]; Wedi, Edris [Author]; Hosseini, Ali Seif Amir [Author]; Kleemann, Tobias [Author]; Schulz, Thomas [Author]; Jung, Carlo [Author]; Thimme, Robert [Author]; Schmidt, Arthur [Author]
  • Published: 25 August 2021
  • Published in: United european gastroenterology journal ; 9(2021), 9 vom: Nov., Seite 1048-1056
  • Language: English
  • DOI: 10.1002/ueg2.12135
  • Identifier:
  • Keywords: over-the-scope clips ; peptic ulcer hemorrhage ; refractory upper gastrointestinal hemorrhage ; transcatheter arterial embolization
  • Origination:
  • Footnote:
  • Description: Background: Transcatheter arterial embolization (TAE) or surgery are standard treatment of peptic ulcer bleeding (PUB) refractory to endoscopic hemostasis. Over-the-scope clips (OTSC) have shown superiority to standard endoscopic treatment. Objective: To compare OTSC treatment to TAE in refractory peptic ulcer bleeding. Patients and Methods: In this retrospective, multicenter study, 128 patients treated with OTSC (n = 66) or TAE (n = 62) for refractory PUB between 2009 and 2019 in four academic centers were analyzed. Primary endpoint was clinical success (hemostasis + no rebleeding within 7 days). Secondary endpoints were adverse events, length of ICU stay, and mortality. Propensity score matching was performed to adjust for differences in baseline characteristics. Results: Patients characteristics were similar in both groups but ulcers in the TAE group were larger, more often located in the duodenal bulb (85.5% vs. 65.2%; p = 0.014), and that the proportion of Forrest Ia bleedings was higher (38.7% vs. 19.7%; p = 0.018). Clinical success was comparable in both groups (74.2% vs. 59.7%; p = 0.092). Stay on the intensive care unit (ICU) was significantly longer in the TAE group (mean 8.0 vs. 4.7 days; p = 0.002). Serious adverse events after re-therapy (12.9% vs. 1.5%; p = 0.042) and in-hospital mortality were significantly higher in the TAE group (9.1 vs. 22.6%, OR 2.92 [95% CI 1.04-8.16]; p = 0.05). After propensity score matching, the differences found regarding ICU stay (4.9± 5.9 and 9.2 ± 11.2; p = 0.009) and in-hospital mortality (5% vs. 22.5%; OR 5.52 [95% CI: 1.11-27.43]; p = 0.048) stayed significant. Conclusions: OTSC treatment for refractory PUB was superior to TAE in terms of ICU stay and in-hospital mortality.
  • Access State: Open Access