Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Gastroenterology and Hepatology, University Hospitals KU Leuven,Herestraat 49, 3000 Leuven, Belgium.
Eur J Radiol. 2023 Sep;166:110970. doi: 10.1016/j.ejrad.2023.110970. Epub 2023 Jul 10.
Long-term outcome and prognostic factors of transcatheter embolization for gastroduodenal peptic ulcer bleeding are unknown. This study was conducted to evaluate the clinical outcome and factors associated with early recurrent bleeding and 30-day mortality of transcatheter arterial embolization (TAE) for severe, upper gastroduodenal hemorrhage associated with peptic ulcer and refractory to medical and endoscopic therapy.
A monocenter, retrospective study from 2005 to 2020 including 76 consecutive patients who underwent TAE as first-line therapy for bleeding gastroduodenal peptic ulcers refractory to endoscopic therapy. Patient demographics, endoscopy findings, co-morbidities and interventional procedure findings were recorded. The outcome measures were technical and clinical success, procedure related complications, recurrent bleeding, length of hospital stay, 30-day mortality and overall survival.
The technical success rate was 96% and the clinical success rate was 65,8%. The rebleeding and 30-day mortality rate were 30,7% and 22,4% respectively. A higher international normalized ratio (INR) was a statistically significant risk factor for 30-day mortality (OR, 7.15; 95% CI, 1.67-30.70; p = 0.008). The mean overall survival was 3.76 years (1.16---5.09; 95% CI); a lower Charlson Comorbidity Index (CCI) and a lower Rockall score were significantly associated with a longer overall survival (HR, 1.24; 95% CI, 1.14-1.35; p = 0.0001; HR, 1.32; 95% CI, 1.10-1.59; p = 0.003) respectively. Early rebleeding was significantly associated with a lower overall survival (HR, 2.72; 95% CI, 1.57-4.71; p = 0.0004).
A higher INR was a significant risk factor with a higher 30-day mortality. A lower CCI, a lower Rockall score and the absence of early rebleeding were significantly associated with a longer overall survival.
经导管栓塞治疗胃十二指肠消化性溃疡出血的长期预后和预测因素尚不清楚。本研究旨在评估经导管动脉栓塞（TAE）治疗因消化性溃疡导致的严重、上消化道出血的临床结果和与早期再出血和 30 天死亡率相关的因素，这些患者对药物和内镜治疗有抵抗性。
这是一项来自 2005 年至 2020 年的单中心回顾性研究，共纳入 76 例连续患者，这些患者因药物和内镜治疗抵抗性的消化性溃疡导致的胃十二指肠出血而行 TAE 作为一线治疗。记录患者的人口统计学、内镜检查结果、合并症和介入手术结果。主要结局指标为技术和临床成功率、与操作相关的并发症、再出血、住院时间、30 天死亡率和总生存率。
技术成功率为 96%，临床成功率为 65.8%。再出血和 30 天死亡率分别为 30.7%和 22.4%。较高的国际标准化比值（INR）是 30 天死亡率的统计学显著危险因素（OR，7.15；95%CI，1.67-30.70；p=0.008）。平均总生存率为 3.76 年（1.16-5.09；95%CI）；较低的 Charlson 合并症指数（CCI）和较低的 Rockall 评分与较长的总生存率显著相关（HR，1.24；95%CI，1.14-1.35；p=0.0001；HR，1.32；95%CI，1.10-1.59；p=0.003）。早期再出血与较低的总生存率显著相关（HR，2.72；95%CI，1.57-4.71；p=0.0004）。
较高的 INR 是 30 天死亡率的显著危险因素。较低的 CCI、较低的 Rockall 评分和无早期再出血与较长的总生存率显著相关。
