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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2020

01-10-2020 | Duodenal Ulcer | Original Article

Management of bleeding peptic duodenal ulcer refractory to endoscopic treatment: surgery or transcatheter arterial embolization as first-line therapy? A retrospective single-center study and systematic review

Authors: Ilan Darmon, Lionel Rebibo, Momar Diouf, Cyril Chivot, Clémentine Riault, Thierry Yzet, Jean Philippe Le Mouel, Jean-Marc Regimbeau

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2020

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Abstract

Background

The objective of this study was to compare the results of transcatheter arterial embolization (TAE) with surgery in terms of efficacy in the context of bleeding duodenal ulcer (BDU) refractory to endoscopic treatment.

Materials and methods

From January 2006 to December 2016, all patients treated for a BDU refractory to endoscopic treatment were included in this observational, comparative, retrospective, single-center study. Primary endpoint was the overall success of treatment of BDU requiring surgical and/or TAE. The secondary endpoints were pre-interventional data, recurrence rates, feasibility of secondary treatment, morbidity and mortality of surgical and radiological treatment, intensive care unit and length of stay. A systematic review of the literature was performed to compare results of surgery and TAE.

Results

59 out of 396 patients (14.9%) treated for BDU required embolization and/or surgery: 15 patients underwent surgery (group S) including 7 patients after embolization failure and 44 patients underwent TAE (group TAE). The overall treatment success in intention to treat (85.7% vs 67.3%), per protocol (80% vs 79.5%) and bleeding recurrence rates (20% vs 15.9%) were also identical. Mortality (14.2% vs 15.3%) was similar between the two groups. Our study data were pooled with data from eight published studies and suggest that surgery have significant increased overall success (68.3% vs. 55.4%, p < 0.005).

Conclusion

The overall success rate was in favour of surgery according our meta-analysis. Our single-center study highlights the fact that predictive factors for recurrent bleeding after TAE must be identified to select good candidates for TAE and/or surgery.
Literature
1.
van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22:209–24.CrossRefPubMed
2.
Barkun AN, Bardou M, Kuipers EJ, et al. International consensus upper gastrointestinal bleeding conference group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–13.CrossRefPubMed
3.
Magalhães Queiroz DM, Luzza F. Epidemiology of helicobacter pylori infection. Helicobacter. 2006;11(Suppl 1):1–5.CrossRefPubMed
4.
Komen NA, Bertleff MJ, van Doorn LJ, Lange JF, de Graaf PW. Helicobacter genotyping and detection in peroperative lavage fluid in patients with perforated peptic ulcer. J Gastrointest Surg. 2008;12:555–60.CrossRefPubMed
5.
Liu T, He W, Li Y. Helicobacter pylori infection of gastric epithelial cells affects NOTCH pathway in vitro. Dig Dis Sci. 2016;61:2516–21.CrossRefPubMed
6.
Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. Dig Surg. 2010;27:161–9.CrossRefPubMed
7.
8.
Chevallier P, Novellas S, Vanbiervliet G, et al. Transcatheter embolization for endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage. J Radiol. 2007;88:251–8.CrossRefPubMed
9.
Brehant O, Fuks D, Sabbagh C, et al. Surgical management of duodenal ulcer with hemorrhage from the gastroduodenal artery: antrectomy versus conservative surgery? J Chir (Paris). 2008;145:234–7.CrossRef
10.
Rösch J, Dotter CT, Brown MJ. Selective arterial embolization. A new method for control of acute gastrointestinal bleeding. Radiology. 1972;102:303–6.CrossRefPubMed
11.
Loffroy R, Guiu B, D'Athis P, et al. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009;7:515–23.CrossRef
12.
Katano T, Mizoshita T, Senoo K, et al. The efficacy of transcatheter arterial embolization as the first-choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors. Dig Endosc. 2012;24:364–9.CrossRefPubMed
13.
Eriksson LG, Ljungdahl M, Sundbom M, Nyman R. Transcatheter arterial embolization versus surgery in the treatment of upper gastrointestinal bleeding after therapeutic endoscopy failure. J Vasc Interv Radiol. 2008;19:1413–8.CrossRefPubMed
14.
Ripoll C, Bañares R, Beceiro I, et al. Comparison of transcatheter arterial embolization and surgery for treatment of bleeding peptic ulcer after endoscopic treatment failure. J Vasc Interv Radiol. 2004;15:447–50.CrossRefPubMed
15.
Venclauskas L, Bratlie SO, Zachrisson K, Maleckas A, Pundzius J, Jönson C. Is transcatheter arterial embolization a safer alternative than surgery when endoscopic therapy fails in bleeding duodenal ulcer? Scand J Gastroenterol. 2010;45:299–304.CrossRefPubMed
16.
Kyaw M, Tse Y, Ang D, Ang TL, Lau J. Embolization versus surgery for peptic ulcer bleeding after failed endoscopic hemostasis: a meta-analysis. Endosc Int Open. 2014;2:E6–E14.CrossRefPubMed
17.
Sverdén E, Mattsson F, Lindström D, Sondén A, Lu Y, Lagergren J. Transcatheter arterial embolization compared with surgery for uncontrolled peptic ulcer bleeding: a population-based cohort study. Ann Surg. 2019;269:304–9.CrossRefPubMed
18.
Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;17(2):394–7.CrossRef
19.
Chivot C, Rebibo L, Robert B, Regimbeau JM, Yzet T. Ruptured pancreaticoduodenal artery aneurysms associated with celiac stenosis caused by the median arcuate ligament: a poorly known etiology of acute abdominal pain. Eur J Vasc Endovasc Surg. 2016;51:295–301.CrossRef
20.
Weinberg JA. Treatment of the massively bleeding duodenal ulcer by ligation, pyloroplasty and vagotomy. Am J Surg. 1961;102:158–67.CrossRefPubMed
21.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
22.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMed
23.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.CrossRefPubMed
24.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRefPubMed
25.
Larssen L, Moger T, Bjørnbeth BA, Lygren I, Kløw NE. Transcatheter arterial embolization in the management of bleeding duodenal ulcers: a 5.5-year retrospective study of treatment and outcome. Scand J Gastroenterol. 2008;43:217–22.CrossRefPubMed
26.
Wong TC, Wong KT, Chiu PW, et al. A comparison of angiographic embolization with surgery after failed endoscopic hemostasis to bleeding peptic ulcers. Gastrointest Endosc. 2011;73:900–8.CrossRefPubMed
27.
Ang D, Teo EK, Tan A, et al. A comparison of surgery versus transcatheter angiographic embolization in the treatment of nonvariceal upper gastrointestinal bleeding uncontrolled by endoscopy. Eur J Gastroenterol Hepatol. 2012;24:929–38.CrossRefPubMed
28.
Nykänen T, Peltola E, Kylänpää L, Udd M. Bleeding gastric and duodenal ulcers: case-control study comparing angioembolization and surgery. Scand J Gastroenterol. 2017;52:523–30.CrossRefPubMed
29.
Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995;311:222–6.CrossRefPubMed
30.
Lu M, Sun G, Zhang XL, et al. Risk factors associated with mortality and increased drug costs in nonvariceal upper gastrointestinal bleeding. Hepatogastroenterology. 2015;62:907–12.PubMed
31.
Quan S, Frolkis A, Milne K, et al. Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. World J Gastroenterol. 2014;20:17568–77.CrossRefPubMed
32.
Satoh K, Yoshino J, Akamatsu T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2015. J Gastroenterol. 2016;51:177–94.CrossRefPubMed
33.
Dousset B, Suc B, Boudet MJ, et al. Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality. Gastroenterol Clin Biol. 1995;19:259–65.PubMed
34.
Millat B, Hay JM, Valleur P, Fingerhut A, Fagniez PL. Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French associations for surgical research. World J Surg. 1993;17:568–73 (discussion 574).CrossRefPubMed
35.
Pautrat K, Valleur P, Pocard M. Urgent surgery for bleeding duodenal ulcer. J Chir (Paris). 2007;144:231–5.CrossRef
Metadata
Title
Management of bleeding peptic duodenal ulcer refractory to endoscopic treatment: surgery or transcatheter arterial embolization as first-line therapy? A retrospective single-center study and systematic review
Authors
Ilan Darmon
Lionel Rebibo
Momar Diouf
Cyril Chivot
Clémentine Riault
Thierry Yzet
Jean Philippe Le Mouel
Jean-Marc Regimbeau
Publication date
01-10-2020
Publisher
Springer Berlin Heidelberg
Keyword
Duodenal Ulcer
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01356-7

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