Over‐the‐scope clip versus transcatheter arterial embolization for refractory peptic ulcer bleeding - a propensity score matched analysis

Abstract: 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

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch
• Notes: United European gastroenterology journal. - 9, 9 (2021) , 1048-1056, ISSN: 2050-6414

Contributors, Places and Time

• Event: Veröffentlichung
• (where): Freiburg
• (who): Universität
• (when): 2021
• Creator: Küllmer, Armin ; Mangold, Tobias ; Bettinger, Dominik ; Maruschke, Lars ; Wannhoff, Andreas ; Caca, Karel ; Wedi, Edris ; Seif Amir Hosseini, Ali ; Kleemann, Tobias ; Schulz, Thomas ; Jung, Carlo ; Thimme, Robert ; Schmidt, Arthur

Further information

• DOI: 10.1002/ueg2.12135
• URN: urn:nbn:de:bsz:25-freidok-2216568
• Rights: Kein Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 25.03.2025, 1:43 PM CET