Transcatheter Arterial Embolization Compared With Surgery for Uncontrolled Peptic Ulcer Bleeding

Objective: To compare key outcomes after transcatheter arterial embolization (TAE) with conventional surgery for peptic ulcer bleeding when endoscopic intervention fails to achieve hemostasis. Background: Mortality in peptic ulcer bleeding remains high, especially in patients who require surgical treatment. Methods: A population-based cohort study in Stockholm, Sweden, in 2000 to 2014, assessing the main outcome all-cause mortality and the secondary outcomes re-bleeding, re-intervention, length of hospitalization, and complications, was conducted. Data were taken from well-maintained registries and medical records. Multivariable Cox-regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, ulcer history, comorbidity, and calendar period were considered. Results: Included were 282 patients, 97 in the TAE group and 185 in the surgery group. Compared with the surgery group, the overall hazard of death was 34% decreased in the TAE group (adjusted HR 0.66, 95% CI 0.46–0.96). The corresponding HRs for mortality within 30 days, 90 days, 1 year, and 5 years were 0.70 (95% CI 0.37–1.35), 0.69 (95% CI 0.38–1.26), 0.88 (95% CI 0.53–1.47), and 0.67 (95% CI 0.45–1.00), respectively. The risk of re-bleeding was higher after TAE compared with surgery (HR 2.48, 95% CI 1.33–4.62). The median length of hospital stay was shorter in the TAE group—8 versus 16 days—acceleration factor 0.59 (95% CI 0.45–0.77) and the risk of complications was lower (8.3% vs 32.2%; P < 0.0001). Conclusions: This study indicates that TAE compares favorably with surgery regarding prognosis after refractory peptic ulcer bleeding, and the shorter length of hospital stay and fewer complications outweigh a higher risk of re-bleeding. TAE could be recommended as first-line treatment for these patients.