• Emma Sverdén, Fredrik Mattsson, David Lindström, Anders Sondén, Yunxia Lu, and Jesper Lagergren.
• Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
• Ann. Surg. 2019 Feb 1; 269 (2): 304-309.

ObjectiveTo compare key outcomes after transcatheter arterial embolization (TAE) with conventional surgery for peptic ulcer bleeding when endoscopic intervention fails to achieve hemostasis.BackgroundMortality in peptic ulcer bleeding remains high, especially in patients who require surgical treatment.MethodsA 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.ResultsIncluded 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).ConclusionsThis 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.

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