Retrospective analysis of surgery and trans-arterial embolization for major non-variceal upper gastrointestinal bleeding

ANZ J Surg. 2016 May;86(5):381-5. doi: 10.1111/ans.12588. Epub 2014 Apr 3.

Abstract

Background: With proton pump inhibitors and current sophisticated endoscopic techniques, the number of patients requiring surgical intervention for upper gastrointestinal bleeding has decreased considerably while trans-arterial embolization is being used more often. There are few direct comparisons between the effectiveness of surgery and embolization.

Methods: A retrospective study of patients from two Australian teaching hospitals who had surgery or trans-arterial embolization (n = 103) for severe upper gastrointestinal haemorrhage between 2004 and 2012 was carried out. Patient demographics, co-morbidities, disease pathology, length of stay, complications, and overall clinical outcome and mortality were compared.

Results: There were 65 men and 38 women. The median age was 70 (range 36-95) years. Patients requiring emergency surgical intervention (n = 79) or trans-arterial embolization (n = 24) were compared. The rate of re-bleeding after embolization (42%) was significantly higher compared with the surgery group (19%) (P = 0.02). The requirement for further intervention (either surgery or embolization) was also higher in the embolization group (33%) compared with the surgery group (13%) (P = 0.03). There was no statistical difference in mortality between the embolization group (5/24, 20.8%) and the surgical group (13/79, 16.5%) (P = 0.75).

Conclusion: Emergency surgery and embolization are required in 2.6% of patients with upper gastrointestinal bleeding. Both techniques have high mortalities reflecting the age, co-morbidities and severity of bleeding in this patient group.

Keywords: endoscopy; peptic ulcer disease; trans-arterial embolization; upper gastrointestinal bleeding.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Catheterization, Peripheral / methods*
  • Embolization, Therapeutic / methods*
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome