Prophylactic angiographic embolisation after endoscopic control of bleeding to high-risk peptic ulcers: A randomised controlled trial
Publication in refereed journal


摘要Objectives In the management of patients with bleeding peptic ulcers, recurrent bleeding is associated with high mortality. We investigated if added angiographic embolisation after endoscopic haemostasis to high-risk ulcers could reduce recurrent bleeding.

Design After endoscopic haemostasis to their bleeding gastroduodenal ulcers, we randomised patients with at least one of these criteria (ulcers≥20 mm in size, spurting bleeding, hypotensive shock or haemoglobin<9 g/dL) to receive added angiographic embolisation or standard treatment. Our primary endpoint was recurrent bleeding within 30 days.

Results Between January 2010 and July 2014, 241 patients were randomised (added angiographic embolisation n=118, standard treatment n=123); 22 of 118 patients (18.6%) randomised to angiography did not receive embolisation. In an intention-to-treat analysis, 12 (10.2%) in the embolisation and 14 (11.4%) in the standard treatment group reached the primary endpoint (HR 1.14, 95% CI 0.53 to 2.46; p=0.745). The rate of reinterventions (13 vs 17; p=0.510) and deaths (3 vs 5, p=0.519) were similar. In a per-protocol analysis, 6 of 96 (6.2%) rebled after embolisation compared with 14 of 123 (11.4%) in the standard treatment group (HR 1.89, 95% CI 0.73 to 4.92; p=0.192). None of 96 patients died after embolisation compared with 5 (4.1%) deaths in the standard treatment group (p=0.108). In a posthoc analysis, embolisation reduced recurrent bleeding only in patients with ulcers≥15 mm in size (2 (4.5%) vs 12 (23.1%); p=0.027).

Conclusions After endoscopic haemostasis, added embolisation does not reduce recurrent bleeding.
著者James Y W Lau, Rapat Pittayanon, Ka-Tak Wong, Nutcha Pinjaroen, Philip Wai Yan Chiu, Rungsun Rerknimitr, Ingrid Lisanne Holster, Ernst J Kuipers, Kai-Chun Wu, Kim W L Au, Francis K L Chan, Joseph J Y Sung
出版社BMJ Publishing Group
頁次796 - 803

上次更新時間 2020-29-10 於 02:09