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

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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.
出版社接受日期04.05.2018
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
期刊名稱Gut
出版年份2019
月份5
卷號68
期次5
出版社BMJ Publishing Group
頁次796 - 803
國際標準期刊號0017-5749
電子國際標準期刊號1468-3288
語言英式英語

上次更新時間 2020-29-10 於 02:09