Over-the-scope clip versus transcatheter arterial embolization for refractory peptic ulcer bleeding: a propensity score matched analysis
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 p...
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| Hauptverfasser: | , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
25 August 2021
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| In: |
United european gastroenterology journal
Year: 2021, Jahrgang: 9, Heft: 9, Pages: 1048-1056 |
| ISSN: | 2050-6414 |
| DOI: | 10.1002/ueg2.12135 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ueg2.12135 Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ueg2.12135 
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| Verfasserangaben: | Armin Kuellmer, Tobias Mangold, Dominik Bettinger, Lars Maruschke, Andreas Wannhoff, Karel Caca, Edris Wedi, Ali Seif Amir Hosseini, Tobias Kleemann, Thomas Schulz, Carlo Jung, Robert Thimme, Arthur Schmidt |
| Zusammenfassung: | 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. |
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| Beschreibung: | Gesehen am 06.11.2024 |
| Beschreibung: | Online Resource |
| ISSN: | 2050-6414 |
| DOI: | 10.1002/ueg2.12135 |