Peptic ulcer bleeding and use of transarterial embolization at a center without on-site interventional radiologists: a retrospective cohort study

OBJECTIVE: To determine the incidence of rebleeding after initial endoscopic hemostasis for peptic ulcer bleeding. Furthermore, to investigate the risk factors for rebleeding, outcomes of this patient group and to assess the effect of prophylactic transarterial embolization (pTAE) in a setting without on-site interventional radiology.

MATERIAL AND METHODS: This single-center retrospective cohort study included patients treated for peptic ulcer bleeding from 2020-2023 at Zealand University Hospital, Denmark. Follow-up was one year. A high-risk subgroup was defined as patients with duodenal ulcer, hemodynamic instability, and Forrest score Ia-IIb. Mortality risk was analyzed using Kaplan-Meier estimation. Patients undergoing pTAE were transferred to a tertiary center.

RESULTS: A total of 174 patients were included. Rebleeding occurred in 28% and was associated with low BMI, smoking, duodenal ulcer, high-risk Forrest classification, and hypotension at admission. Rebleeding was linked to longer hospital stay and higher rates of adverse events, but no significant difference in mortality. The high-risk subgroup had significantly higher rebleeding rates and 90- and 365-day mortality. Ten patients (6%) underwent pTAE after initial endoscopic hemostasis with rebleeding and mortality rates equal to the non-pTAE group. Among 49 patients with rebleeding, 25% underwent pTAE after a second successful endoscopic intervention and had lower one-year mortality compared to those without pTAE (17% vs. 43%).

CONCLUSION: Rebleeding after initial successful endoscopic hemostasis for peptic ulcer bleeding was frequent and associated with adverse clinical outcomes, but not increased mortality. Patients undergoing pTAE after rebleeding had lower mortality, but the limited number of pTAE patients precluded firm conclusions on the effect.