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
| Autor: | Cyril Chivot, L. Rebibo, Ilan Darmon, Momar Diouf, Jean-Marc Regimbeau, Jean Philippe Le Mouel, Thierry Yzet, Clémentine Riault |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care medicine.medical_treatment Peptic Context (language use) Critical Care and Intensive Care Medicine Single Center Endoscopy Gastrointestinal law.invention 03 medical and health sciences 0302 clinical medicine Recurrence Risk Factors law medicine Clinical endpoint Humans Orthopedics and Sports Medicine Embolization Aged Retrospective Studies Aged 80 and over 030222 orthopedics Intention-to-treat analysis business.industry Arterial Embolization Angiography 030208 emergency & critical care medicine Length of Stay Middle Aged Embolization Therapeutic Intensive care unit Surgery Peptic Ulcer Hemorrhage Emergency Medicine Female business Systematic Reviews as Topic |
| Zdroj: | European Journal of Trauma and Emergency Surgery. 46:1025-1035 |
| ISSN: | 1863-9941 1863-9933 |
| DOI: | 10.1007/s00068-020-01356-7 |
| Popis: | 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. 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. 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 |
| Databáze: | OpenAIRE |
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